Radiation-induced fistula in a 60-year-old woman with recurrent stage IB endometrial carcinoma who had undergone hysterectomy. Left-sided hydronephrosis due to pelvic recurrence was treated with ureteric stent placement, adjuvant chemotherapy, and radical radiation therapy. Routine follow-up CT and MR imaging were performed 4 months after treatment. (a) Coronal CT scan shows a left ureteric stent in situ. Gas is seen within the proximal right ureter (arrow) consistent with a fistula. (b) Sagittal T2-weighted MR image shows a low-signal-intensity area (white *) consistent with air and a high-signal-intensity area (black *) consistent with vesical fluid, findings that are indicative of a fistula. (c) Corresponding sagittal T1-weighted MR image obtained following intravenous contrast material administration shows a fistulous tract connecting the bladder to the vagina (arrow) and the vagina to the rectum (arrowhead). (d) Sagittal spot image from a vaginographic examination performed in a different patient with the instillation of water-soluble contrast material into the vagina (black arrow) via a urinary catheter shows a fistula containing contrast material within the sigmoid colon (white arrow).

Figure 8a.

Figure 8b.

Figure 8c.

Figure 8d.