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URETERO-ENTERIC FISTULA
Authored By: tdeshm01 and Barry Siegel, Prof of Radiology.
Patient: 72 year old female
History: 72-year-old woman with stage III-B cervical cancer treated with radiation and chemotherapy 5 years ago. She underwent pelvic tumor debulking with rectosigmoid resection and colostomy one year ago.
Image Size:[small][as-submitted]

Fig. 1
Coronal PET

Fig. 2
Axial, sagittal and coronal PET-CT

Fig. 3
Axial PET-CT

Fig. 4
Axial PET-CT

Fig. 5
Axial PET-CT

Fig. 6
Axial PET-CT

Fig. 7
Left antegrade nephrostogram
Image Size:[small][as-submitted]

Findings:

PET-CT

RADIOPHARMACEUTICAL: 14.7 mCi F-18 Fluorodeoxyglucose (FDG) i.v.

 

Findings: 

1. Large mass with intense FDG uptake around the distal left ureter.

 

2. Air in the left renal pelvis with peripelvic stranding, and intense activity in the abutting ileal segments. Left ureteral stents remains in place.

 

3. Focus of increased FDG uptake in the right lobe of the liver, without CT correlate.

 

 

Diagnosis:

PET-CT:

 

1. Recurrent cervical cancer around the distal left ureter.

 

2. Left uretero-ileal fistula, evidenced by air in the left renal pelvis with peripelvic stranding, and intense activity (urine) in the abutting ileal segments.

 

3. Right hepatic lobe metastases.

 

 

LEFT ANTEGRADE NEPHROSTOGRAM:

 

There is opacification of the left nephrostomy catheter and ureteral stent. In the region of the distal ureter, there is opacification of a small segment of small bowel suggestive of a distal uretero-enteric fistula.

General Discussion: Management:   A left percutaneous nephrostomy was performed and the left ureteral stents were removed.
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Additional Details:

Case Number: 248470Owner(s): tdeshm01 and Barry Siegel, Prof of RadiologyLast Updated: 12-07-2011
Anatomy: Genitourinary (GU)   Pathology: Neoplasm
Modality: Other, PETAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: ptnm

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