Foreign body mimicking neoplasia of the renal pelvis on magnetic resonance imaging

Abstract

A 65-year-old male presented with an incidental magnetic resonance imaging (MRI) finding of a right renal pelvis (RP) tumor-like mass. He was subjected to nephrostomy tube (NT) placement due to hydronephrosis secondary to an impacted ureteral stone. NT was removed after successful Ho:YAG laser lithotripsy. Abdominal MRI performed 19 months later for another indication showed RP wall thickening/enhancement and an intrapelvic low-intensity linear structure presenting as a magnetic susceptibility artifact. He underwent diagnostic ureterorenoscopy/retrograde intrarenal surgery. A calcified NT locking suture remnant was found within the pelvis surrounded by reactive edema without evidence of tumor. Foreign body (FB) was removed after disintegration of surrounding calcifications using Ho:YAG laser. This is the first case of a calcified NT locking suture remnant mimicking RP tumor on MRI. The case underlies the importance of safe NT removal. Specific MRI findings may prove valuable for preoperative diagnosis of intrarenal FBs in cases with history of endourological interventions evaluated for upper urinary tract masses. Multidisciplinaryuroradiological approach of such cases is essential.

Management Challenges of Ureteral Foreign Body-Clinical Vignette and Review of Literature

“…Four case reports revealed suture material as a foreign body in the ureters causing encrustation and calcification. 3,8,10,13 Case reports by Qublan et al and Mamoulakis et al revealed intrauterine contraceptive device as a foreign body both in the distal ureters. 3,12 Metallic clip was reported by 2 studies as a ureteral foreign including the highlighted case in figures below.…”

“…Other symptoms reported were flank pain, 3-5,10,11 followed by dysuria, 2,5,8,12 along with two incidental findings from imaging. 1,13 A total of 10/14 of the case reports, (Figure 3 and 4) 2,5-10,13 highlighted ureteroscopy + holmium laser fragmentation of calcification along with grasping forceps for retraction of foreign body . Li et al reported a laparoscopic left nephroureterectomy for a nonfunctioning kidney after lodging an intrauterine contraceptive device in the left distal ureter for 3 years.…”

“…3 Therefore nephro-ureteroscopy is a useful adjunct for diagnosis and treatment. 3,4,8,13 This allows lasers fragmentation of stone 3,10,13 as well as extraction of foreign body using grasping forceps. 9,10,13 Methods for in the (Figures 1-4).…”

“…3,4,8,13 This allows lasers fragmentation of stone 3,10,13 as well as extraction of foreign body using grasping forceps. 9,10,13 Methods for in the (Figures 1-4). The review was conducted using the following electronic databases PubMed, African Journal Online, Google and Google Scholar.…”

“…[1][2][3][4] Migration or erosion of suture materials, mesh, Hemo-Lok clips, metallic clips, vascular graft materials, coils used for embolization, guidewire introducer, suprapubic catheter, intrauterine contraceptive device into the ureters have been reported in the literature. [1][2][3][4][5][6][7][8][9][10][11][12][13] In some clinical scenarios, symptoms such as flank pain, urinary tract infections, and lower urinary tract symptoms (frequency, hematuria, and dysuria) may be an indication for a foreign body erosion into the urinary tract. 3,4,9 extraction of such foreign bodies may also depend on the anatomical location, size, shape, and mobility of the object.…”