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Case of the Month 01/10

This 76 year old female with PMH of AAA post endovascular and then open repair 3 weeks prior presented to ED complaining of 3 days of shortness of breath. She also complained of back pain which she attributed to an uncomfortable bed at the nursing home.
Below are CT images taken while in the ED.

Question 1: What's wrong with these pictures?

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Answer 1:

There is a large left retroperitoneal fluid collection adjacent to the recently repaired aortic aneurysm (note the stent in the aorta.) Because there were several small foci of gas noted inside of this collection, it was thought to represent an infected retroperitoneal hematoma secondary to aortic leakage.

Question 2: During a follow up CT done with IV contrast 8 days later, the following images were obtained. What is your diagnosis now?

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Answer 2:

The bright white line ( circled) is leakage of IV contrast from a disrupted ureter. The reading of these IV contrast images was “persistent retroperitoneal collection most likely represents a urinoma.” She was thought by the surgical team to have had both an infected retroperitoneal hematoma and a urinoma due to ureteral injury.