Patient is POD 14 from radical hysterectomy and is having persistent leaking of urine around the Foley and urine in vagina. Looking for evidence of vesicovaginal fistula versus ureterovaginal fistula. PELVIS:UTERUS, ADNEXA: Post-surgical findings of hysterectomy. Ovaries are unremarkable in appearance.BLADDER: Foley catheter terminates in a partially collapsed bladder. Secondary inflammatory thickening of the posterior bladder wall due to the central pelvic fluid collection described below.LYMPH NODES: Post-surgical findings of lymph node dissection. Prominent inguinal lymph nodes, likely reactive.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral well-circumscribed fluid signal foci along the bilateral external iliac chains consistent with nonspecific post-surgical fluid collections, possibly lymphoceles; special attention on follow-up scans. The larger one on the right measures 4.2 x 2.9 cm (series 401, image 50).Post-surgical subcutaneous edema in the anterior pelvic wall.OTHER: Fistulous communication between the distal left ureter and a 3 x 2.5 cm left hemipelvis collection located posterior to the proximal external iliac vasculature (series 1001, image 373; series 1005, image 370). Additional fistulous connection between this left sided collection and a central 6.2 x 2.9 cm collection immediately superior to the vaginal cuff (series 1001, image 298).No discrete fistulous tract between the vagina and bladder is identified on background of extensive surgical change.Small amount of nonspecific pelvic fluid, possibly represents urine.
Left ureterovaginal fistulous network communicating through two fluid collections in the left hemipelvis and at the vaginal cuff.