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Images in surgery

“Jet sign” in posterior - A radiological icon

Iqbal Singh*, Praveen Kumar# *M.Ch (Urology)[AIIMS], Consultant Urologist & Reader, #MBBS, Post Graduate Junior Resident, Dept of Surgery, University College of Medical Sciences, University of Delhi, G.T.B. Hospital, India.

How to cite this article: Singh I, Kumar P. “Jet sign” in posterior urethral stricture-A radiological icon. Indian J Surg 2004;66:242.

A 28-year-old adult male presented with complaints was performed successfully. Post of slow gradual diminution of the urinary stream. He operatively at three months he continues to void with was found to be having normal urine parameters and a satisfactory uroflow rate. an obstructive uroflow. There was no clinical and microbiological evidence of an active urinary tract We propose a “urethral jet sign” for diagnosis of annular infection. A retrograde urethrogram was done in the urethral strictures. The “jet sign” has been described in radiological suite under realtime showed several other conditions in the human body such as an acute narrowing of the membranous and retrograde tricuspid regurgitant jets on distal bulbar dilatation with a fountain jet spraying of in coronary sinus dilatation,1 aortic the contrast directed towards the bladder lumen jet signs in intimal tears and thoracic aortic dissections (Figure 1). On cystocopic evaluation a membranous on gated magnetic resonance images,2 and absent urethral stricture with a small central annular pinpoint ureteral jets on an antenatal color doppler ultrasound orifice (lumen) was found, that was negotiated by a in women indicating ureteral obstruction.3 The scientific Zebra™ 0.028 guide wire and a direct optical internal basis for a “jet sign” may be that due to the entry of a high pressure flow of contrast suddenly across a pin point area of narrowing with sudden turbulence occurring with increased flow in to a low pressure capacious reservoir (Bernoulli’s principle) such as the bladder in this case. The “jet sign” may be useful in diagnosing a posterior urethral stricture, bladder neck stenosis or cicatrized post prostatectomy bladder neck contracture.

REFERENCES

1. D’Cruz IA, Shirwany A. Update on echocardiography of coronary sinus anatomy and physiology. Echocardiography 2003;20: 87-95. 2. Chung JW, Park JH, Kim HC, Han MC. Entry tears of thoracic aortic dissections: MR appearance on gated SE imaging. J Comput As- sist Tomogr 1994;18:250-5. 3. Wachsberg RH. Unilateral absence of ureteral jets in the third tri- Figure 1: A retrograde urethrogram with a jet fountain spray of mester of pregnancy: Pitfall in color Doppler US diagnosis of uri- contrast suggestive of an annular urethral stricture. nary obstruction. 1998;209:279-81.

Address for correspondence: Dr. Iqbal Singh, F-14, South Extension Part-2, New Delhi - 110049, India. E-mail: [email protected] Paper Received: Febraury 2004. Paper Accepted: August 2004. Source of Support: Nil.

242 Indian Journal of Surgery 2004 Volume 66 Issue 4 (August)