PICTORIAL

Pyelointerstitial, Pyelovenous, and Pyelosinus Backflow During Retrograde Pyelography

Wojciech Szewczyk1*, Andrzej Prajsner,1 Michal Szewczyk2

Keywods: backflow; percutaneous nephrolithotomy; pyelovenous; pyelosinus.

A 65-year-old male was admitted to the hospital for percutaneous  nephrolithotripsy because of a stone in the pelvis of the right kidney. During the retrograde pyelography a very discreet pyeloiterstitial backflow, and a 
massive backflow to the main renal vein was seen (Figure 1). About one minute after first injection of the contrast 
medium, pyelovenous backflow was no more observed, while pyelosinus  backflow was clearly present (Figure 
2). Repeated injection of small amount of contrast medium resulted in almost immediate pyelovenous backflow, 
and persistent  pyelosinus  backflow (Figure 3). 
For fear of massive absorption of irrigation fluid during percutaneous procedure, a classic open pyelolithotomy 
was performed. The patient was discharged from hospital on the sixth day after surgery. Pyelovenous backflow is 
rarely discussed in the literature. Static radiographs rarely catch this quick mowing event.(1,2,3)

1 Department of Urology in Sosnowiec of Medical University of Silesia in Katowice, Poland.
2 student of the Medical University of Silesia in Katowice, Poland.
*Correspondence: Wojciech Szewczyk, Department of Urology in Sosnowiec of Medical University of Silesia in 
Katowice, Poland.
Tel.+48 602600813. E-mail: szewczykw@wp.pl.
Received June 2016 & Accepted November 2016

Figure1. Pyelointerstitial backflow during retrograde pyelogra-
phy, seen as wedge-shaped striated area of blush extending  from 
a calyx (arrowhead). Pyelovenous  backflow showed massive flow 
of contrast agent into the main renal vein (thick arrow).

Figure 2. Pyelosinus backflow (headarrow) after retrograde pye-
lography. Contrast entered the renal sinus and obscured the renal 
collecting system.

Figure 3.  Pyelovenous backflow (arrow) and pyelosinus back-
flow (headarrow) during retrograde pyelography, could be seen 
at the same time.

Pictorial    2932



Backflow in retrograde pyelography- Szewczyk et al.

REFERENCES
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10.1186/1752-1947-4-93.

 2. Tezval H, Matuschek I, Jonas U. Pyelovenous 
backflow or veno-caliceal valve fistula? Scand 
J Urol Nephrol. 2007; 41(4): 346-8.

 3. Nemeth AJ, Patel SK. Pyelovenous backflow 
seen on CT Urography. AJR.  2004; 182(2): 
532-3.

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