Skip to main content
NCBI home page
Molecular Imaging and Radionuclide Therapy logoLink to Molecular Imaging and Radionuclide Therapy
. 2019 Sep 6;28(3):123–125. doi: 10.4274/mirt.galenos.2018.14632

Incidental “Urinoma” in 18F-FDG PET/CT Scan

18F-FDG PET/BT Taramasında Tesadüfi “Ürinoma”

Aziz Gültekin 1,*, Olga Yaylalı 1, Tarık Şengöz 1, Doğangün Yüksel 1
PMCID: PMC6746009  PMID: 31507146

Abstract

18F-FDG PET/CT scanning was performed for the primary staging of a 47-year-old man with urothelial carcinoma. The patient underwent biopsy by ureteroscopy 15 days ago and the PET images revealed 18F-FDG accumulation in the right retroperitenal region, compatible with an “urinoma”.

Keywords: Urothelial carcinoma, urinoma, positron emission tomography

Figure 1.

Figure 1

Open in a new tab

A 47-year-old man with a diagnosis of urothelial carcinoma was referred for primary staging with 18F-FDG PET/CT scan. The 18F-FDG PET/ CT scanning was performed 15 days after ureteroscopic biopsy. Imaging was performed 60 minutes after I.V. injection of 395 MBq 18F-FDG, on an integrated 16 slice PET/CT, with scanning from the skull base to the knee. 18F-FDG PET/CT images [(A) MIP; (B) axial fusion; (C) axial CT; (D) sagittal fusion; (E) sagittal CT) showed tracer accumulation in the fluid collection extending to the pelvis along the retroperitoneal area (SUVmax: 4.90, mean density; 1 Hounsfield units), associated with the right ureter, in the right iliopsoas region adjacent to the muscle (A-E blue arrows).

Figure 2.

Figure 2

Open in a new tab

Contrast enhanced CT image before the biopsy (A) and CT image of PET/CT after the biopsy (B). Urinoma was shown (B blue arrows) on the right iliopsoas muscle. CT scanning results of the patient before and after the biopsy procedure were compared and it was recognized that the lesion associated with the right ureter, emerging following the biopsy procedure was a lesion in fluid density consistent with urinoma.

Urinomas may be asymptomatic and occult initially, but may lead to abscess formation and electrolyte imbalances if not diagnosed and managed appropriately (1). Ureteral leaks can result from trauma, ureteral obstruction, tumors or endourologic interventional procedures (2,3,4). The second most common complication of abdominal laparoscopic surgery is ureteral injury (5). Urinomas are rare complications of ureteroscopy. The diagnosis is usually made by ultrasound or CT (2). The incidental discovery of a urinoma by 18F-FDG PET/CT was previously reported (6,7). In our case, urinoma originating from iatrogenic urinary tract injury following endourological biopsy procedure was detected incidentally on PET/CT scan.

Footnotes

Ethics

Informed Consent: Consent form was filled out by the patient.

Peer-review: Externally and internally peer-reviewed.

Authorship Contributions

Concept: A.G., O.Y., Design: A.G., O.Y., Data Collection or Processing: A.G., O.Y., Analysis or Interpretation: A.G., O.Y., T.Ş., D.Y., Literature Search: A.G., Writing: A.G., D.Y.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study received no financial support.

References

  • 1.Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 2003;23:1133–1147. doi: 10.1148/rg.235035029. [DOI] [PubMed] [Google Scholar]
  • 2.Gayer G, Zissin R, Apter S, Garniek A, Ramon J, Kots E, Hertz M. Urinomas caused by ureteral injuries: CT appearance. Abdom Imaging. 2002;27:88–92. doi: 10.1007/s00261-001-0052-5. [DOI] [PubMed] [Google Scholar]
  • 3.Desai MM, Gill IS, Kaouk JH, Matin SF, Novick AC. Laparoscopic partial nephrectomy with suture repair of the pelvicaliceal system. Urology. 2003;61:99–104. doi: 10.1016/s0090-4295(02)02012-5. [DOI] [PubMed] [Google Scholar]
  • 4.Ghali AM, El Malik EM, Ibrahim AI, Ismail G, Rashid M. Ureteric injuries: diagnosis, management, and outcome. J Trauma. 1999;46:150–158. doi: 10.1097/00005373-199901000-00026. [DOI] [PubMed] [Google Scholar]
  • 5.Cadeddu JA, Wolfe JS Jr, Nakada S, Chen R, Shalhav A, Bishoff JT, Hamilton B, Schulam PG, Dunn M, Hoenig D, Fabrizio M, Hedican S, Averch TD. Complications of laparoscopic procedures after concentrated training in urological laparoscopy. J Urol. 2001;166:2109–2111. [PubMed] [Google Scholar]
  • 6.Sanchez MJ, Caride VJ. Incidental, early diagnosis of urinoma by F-18 FDG PET/CT. Clin Nucl Med. 2005;30:102–104. doi: 10.1097/00003072-200502000-00007. [DOI] [PubMed] [Google Scholar]
  • 7.Dias AH, Ipsen P, Bouchelouche K. Incidental Diagnosis of a Large Retroperitoneal Urine Accumulation (Urinoma) on an 18F-FDG PET/CT Scan Performed for Primary Staging of Urothelial Carcinoma. Clin Nucl Med. 2017;42:626–627. doi: 10.1097/RLU.0000000000001691. [DOI] [PubMed] [Google Scholar]

Articles from Molecular Imaging and Radionuclide Therapy are provided here courtesy of Galenos Yayinevi

RESOURCES