CT Appearances of Ketamine-Induced Uropathy: A Guide to General Radiologists

Ketamine-induced uropathy (KIU) is a chronic inflammatory condition in the urinary tract, particularly involving the urinary bladder, in patients with chronic ketamine abuse. It is a growing clinical issue in the younger population, affecting the quality of life. A 28-year-old female patient presented to the Accident and Emergency Department with on-and-off flank pain for one week and later developed severe left flank pain. She also had long-standing urine incontinence with a five-year history of ketamine abuse. A non- contrast computed tomography of the kidneys, ureters, and bladder (CT KUB) was performed to rule out urinary tract stones in the acute clinical presentation. Later, a multiphase CT urogram was performed to assess the renal tracts and urinary bladder on suspicion of KIU. On imaging, a small-volume, thick-walled bladder, perivesical fat stranding, and thickening of the left distal ureter resulting in upstream urinary tract dilatation were observed. Diagnosis of KIU was made by linking the clinical history and the imaging appearances. She was transferred to a specialised centre for management with continuous follow-ups and monitoring of renal and liver functions. The imaging features of KIU are well described in the literature. Typical findings include a contracted small-capacity bladder with perivesical fat stranding, upper urinary tract dilatation, and ureteric wall thickening. However, these features are not specific and may overlap with a range of inflammatory and infective pathologies affecting the urinary tract, highlighting the importance of correlating imaging findings with clinical history and risk factors. Radiologists play a central role in detecting these abnormalities in the acute setting, frequently providing the first indication of an underlying ketamine-related disorder, as ketamine misuse is often not disclosed or recognized at initial presentation. Early recognition of these imaging features can expedite diagnostic workup and support targeted clinical management. The mainstay of treatment is termination of ketamine use, and a multidisciplinary approach is needed for management.