Contrast-Enhanced CT-guided Biopsy for IgG4-Related Disease of the Ureter: a Case Report

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The patient was a 44-year-old man with gross hematuria and left lumbago. Computed tomography (CT) showed thickening of the left ureteral wall. Serum immunoglobulin (Ig) G4 level was high (348 mg/dl). To definitively diagnose IgG4-related disease, we initially planned CT-guided biopsy of the ureter. However, biopsy seemed to pose a risk of ureteral perforation. Iodinated contrast medium was therefore administered during the procedure. While contrast agent was discharged into the ureter, the biopsy needle was carefully advanced under CT fluoroscopy in a direction to avoid the visualized ureteral lumen. Tissue was successfully collected from the ureteral wall without causing any complications and a pathological diagnosis was reached. CT-guided biopsy was thus effective for IgG4-related disease of the ureter in this case.