E1341. Imaging of Percutaneous Nephrostomy Complications
  1. Esraa Al-Jabbari; University of Texas Medical Branch
  2. Shahin Owji; University of Texas Medical Branch
  3. Hasan Khan; University of Texas Medical Branch
  4. Peeyush Bhargava; University of Texas Medical Branch
Since it was initially described by Goodwin et al in 1955, percutaneous nephrostomy (PCN) has become a procedure widely performed by radiologists for both temporary and permanent management of renal tract obstruction. There are several indications for treatment with PCN, including relief of urinary obstruction (ie. urosepsis, acute renal failure); urinary diversion (ie. urinary leaks or fistulae, hemorrhagic cystitis); access for endourologic treatment (ie. nephrolithiasis, ureteral stricture, or occlusion); and certain diagnostic tests (anterograde pyelography, ureteral perfusion). Despite its ability to effectively manage a broad range of conditions affecting the urinary system, PCN is also associated with major and minor complications that often require timely detection and treatment. The rate of these complications ranges from 1% to 10%, including infection (renal/perinephric abscess, pyelonephritis, septic shock, infection along the tubing track); hemorrhage (parenchymal, subcapsular, or perinephric hematoma); injury to surrounding structures (bowel transgression, splenic/liver injury, pleural injury); vascular complications (arteriovenous fistulae, pseudoaneurysm); injury to the collecting system (urine leak, urinoma); and catheter misplacement (uncoiling, migration).

Educational Goals / Teaching Points
Upon review of our educational exhibit, learners will be able to describe the spectrum of complications that may develop secondary to PCN and their respective predisposing risk factors; develop a fundamental understanding of characteristic imaging findings observed in different complications of PCN; summarize next steps in the diagnostic workup and management of these presenting complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Many of the characteristic findings for these various complications can be appreciated on computed tomography (CT). Given the widespread use of PCN and the real potential for life-threatening complications, it is important to be acutely aware of how these complications may present on CT at various stages in the disease process in order to inform appropriate management. Herein, we would like to review and describe the key radiologic signs of PCN complications as recognized on CT, highlighting classic findings seen within the diverse patient population served at our facilities and briefly discussing the most current literature on PCN technique, indications and contraindications, and management of complications.

Percutaneous nephrostomy is a minimally invasive procedure and an alternative for therapy of a number of urologic conditions. However, as any other procedure, it carries a risk of complications. These complications can range from minor complications that require no specific therapy to life-threatening complications that need immediate intervention. Familiarity of potential complications and their imaging characteristics is crucial to guide management.