Pyelolymphatic backflow: branching contrast hints at lymphatic leak

Branching linear contrast extending toward the renal cortex and along hilar lymphatics after forniceal rupture indicates pyelolymphatic backflow, not just urinoma. This subtle sign reflects lymphatic absorption of extravasated contrast.

• The branching linear contrast pattern extending toward the renal cortex and hilar lymphatics is the hallmark of pyelolymphatic backflow.
• It results from forniceal rupture with lymphatic uptake of extravasated contrast, distinct from simple urinoma or collecting system leak.
• Early recognition prevents misdiagnosis and unnecessary interventions.

Automated summary

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