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All sourcesNASA NTRSDOE OSTI
DOE OSTI2025

Virtual Reality for Shoot/No-Shoot Decision Training in Law Enforcement: A Literature Review and Research Agenda

Virtual reality (VR) can materially improve “shoot / no-shoot” (SNS) training by giving officers realistic, repeatable practice making high-stakes decisions under pressure. Traditional tools—live-fire ranges and video simulators—build basics, but they cannot adapt to each officer in real time or fully mirror the complexity of the field. VR closes that gap by creating immersive scenarios that are safer, more flexible, easier to scale across units, and able to capture objective performance data. SNS decisions are not just about marksmanship; they rely on perception, judgment, memory, and the ability to hold fire when a threat is uncertain. Effective training therefore needs realism, decision complexity, and branching outcomes that reflect the true consequences of choices. These elements strengthen recognition of hostile intent while reducing false positives and building the self-control required in ambiguous situations. VR brings specific advantages: dynamic environments, full-body interaction, and the ability to measure performance with precision—enabling targeted feedback and better transfer of learning to the street. At the same time, responsible deployment must address scenario quality (credible environments and behaviors), lawful decision models, and user wellbeing (appropriate stress levels, comfort, and safety). Sandia’s VIPER Lab is positioned to lead this work. The team combines human-performance science, AI/ML, and VR/AR development with a deep equipment bench (e.g., omnidirectional treadmill, eye-tracking, haptics, multiple HMDs). This ecosystem supports building and validating next-generation SNS training that is immersive, measurable, and trustworthy. Bottom line: Investment in VR-enabled SNS training that blends evidence-based design with careful validation and legal safeguards is expected to pay off in safer, more consistent decision-making and improved community trust, delivered through training that is practical to deploy at scale.

45 MILITARY TECHNOLOGY, WEAPONRY, AND NATIONAL DEF↗
DOE OSTI2025

Unrolled Video Super-Resolution Network with Autoregressive Prior for the Case of Known Motion

Real-time detection and classification of distant objects is necessary for many national security applications. However, when objects are far from the sensor, they occupy only a small number of pixels in the captured video, limiting the amount of visual detail available for recognition. State-of-the-art classification methods typically rely on high-resolution (HR) video streams to capture characteristic object features, but obtaining such detail is challenging for distant objects that occupy only a few pixels. This motivates the development of video super-resolution (VSR) methods that enhance object classification by recovering fine details from low-pixel representations. Current VSR methods rely either on model-based optimization, which is interpretable but computationally expensive, or on learning-based approaches, which are efficient and high-performing but often lack flexibility and interpretability. In this report, we propose an end-to-end trainable unrolled VSR network, UVSRNet, which super-resolves each frame in a video by exploiting sub-pixel motion between neighboring low-resolution (LR) frames as well as incorporating high-frequency detail from previously super-resolved frames. In particular, by unrolling a plug-and-play (PnP) half-quadratic splitting (HQS) algorithm, we leverage a model-based data-fitting module alongside a learning-based autoregressive prior module. This combination yields a method that maintains the flexibility and interpretability of model-based methods while achieving the performance advantages of learning-based methods.

45 MILITARY TECHNOLOGY, WEAPONRY, AND NATIONAL DEF↗
DOE OSTI2025

Phylogenomic discovery and engineering of nitrogen fixation into the bioenergy woody crop poplar

Biological nitrogen fixation (BNF) is a key process enabling plants in specific lineages to convert atmospheric dinitrogen (N₂) into bioavailable ammonia through symbioses with diazotrophic microbes. Expanding this capability beyond native nitrogen-fixing clades into non-nodulating crops would reduce synthetic fertilizer use, lowering energy inputs and environmental impacts in agriculture. Supported by DOE Funding Award DE-SC0018247, the NitFix project advanced foundational knowledge required to engineer root-nodule symbioses in new host species. The team generated the most comprehensive phylogenomic analysis to date of all known nodulating lineages, resolving the evolutionary history of nitrogen-fixing symbiosis and identifying core gene suites retained across nodulating taxa. Through multimodal genomics, transcriptomics, and functional analyses in Medicago truncatula and related species, the project mapped regulatory networks underlying nodule organogenesis, bacterial infection, and nitrogen-fixation efficiency. Key discoveries include the identification of conserved signaling modules for rhizobial recognition, transcription factors controlling nodule differentiation, and metabolic pathways integrating fixed nitrogen into plant growth. The project also developed enabling tools—including optimized transformation pipelines, gene-editing workflows, and imaging-based phenotyping—to accelerate engineering efforts in emerging models. Together, these results refine the mechanistic framework of symbiotic nitrogen fixation and highlight transferable components essential for rewiring these traits into non-nodulating crops.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2025

Reticular Materials and AI-Driven Computer Simulations for Seawater Mining of Valuable Metals (Final Technical Report)

This Final Technical Report describes our exploratory efforts that combine reticular materials synthesis (hydrolytically robust metal–organic frameworks, MOFs) with AI‑enabled molecular simulations to develop mechanistic, quantitative design rules for recovering lithium and other alkali-metal ions from highly dilute, competitive aqueous resources (e.g., seawater). The central outcome is a joint experimental–computational study of ion uptake in MOF‑808 (Chemical Science, 2025) that quantifies both thermodynamics and kinetics of Li + , Na + , and K + uptake and identifies how pore size, pore hydration state, dehydration penalties, and pore-window transport barriers govern selectivity. Guided by these insights, we synthesized and tested functionalized MOF‑808 and multivariate MOFs incorporating ion-recognition motifs (including carboxylates and crown-ether linkers) and evaluated uptake in synthetic seawater, highlighting framework topology and pore chemistry as levers for improved Li + /Na + discrimination. We also developed transferable simulation models, enhanced-sampling protocols, and automated workflows that enable systematic screening of porous sorbents.

42 ENGINEERING↗
DOE OSTI2025

Closeout Report of BNL LDRD 23-050 A Second EIC Detector: Physics Case and Conceptual Design

This document is the closeout report for LDRD 23-050, a type-A LDRD project awarded in FY2022 under the title “ A Second EIC Detector: Physics Case and Conceptual Design ”. The project was motivated by the strong interest within the EIC community in a second general-purpose detector and interaction region, and by the recognition that such a detector is essential to fully exploit the scientific potential of the EIC over its multi-decade lifetime. The key goals of the LDRD were to (i) strengthen the case for a second EIC detector, building on the arguments already articulated in the community Yellow Report, (ii) provide a realistic detector concept that is complementary to the current project detector, ePIC, in terms of physics reach, precision, and control of systematics, and (iii) broaden the overall physics program of the EIC facility. Since a possible second detector is expected to be realized with a delay of several years relative to the first detector, the project explicitly aimed at identifying technologies that are not yet sufficiently mature for ePIC but could be deployed on the later timescale of a second detector, thereby providing genuine complementarity and room for innovation. LDRD 23-050 provided support for two postdoctoral researchers and partial support for several BNL staff members, and the effort ramped up in mid-2023. Work was carried out in close collaboration with colleagues from the EIC project, the Cold QCD and STAR groups at BNL, and with substantial input from members of the EIC User Group and the ePIC Collaboration as reflected in the author list. Over the period from October 2022 through September 2025, this team developed and refined a physics program tailored to a second detector, translated the resulting physics requirements into detector-level performance targets, and explored multiple conceptual detector layouts capable of meeting these targets within the constraints of the second interaction region. The expected outcome, as stated in the original proposal, was a document detailing the physics potential and requirements of a second EIC detector, accompanied by a comprehensive conceptual detector design and an outline of the remaining R&D needed to bring the relevant technologies to maturity. The present report summarizes the progress that has been achieved toward these goals. It consolidates the physics studies, detector concepts, and technology assessments developed under this LDRD and places them in the broader context of worldwide detector R&D. While the evolving priorities of the EIC project and the substantial community effort required to design and construct ePIC naturally limited the scope of EIC-wide activities toward a second detector during this period, the work documented here is intended to provide a foundation and a point of reference for future efforts. Whatever form a second EIC detector may ultimately take, we hope that this report will serve as a useful guide for colleagues who continue to advance this program in the near- and mid-term future.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗
DOE OSTI2024

Industry Scan of Non-SF6 Gas-Insulated Technologies

Sulfur Hexafluoride (SF 6 ) is a specialty gas with excellent electrical insulation properties which has been used extensively in the power industry. This gas is unfortunately also one of the most potent greenhouse gases known to humanity. A 2014 report by the Intergovernmental Panel on Climate Change found that SF 6 has a global warming potential (GWP) 23,000 times higher than Carbon Dioxide, and has the highest GWP of all gases assessed (Myhre 2013). SF 6 is almost exclusively man-made and is produced for use as an insulator in high voltage electrical equipment. This makes the production and use of SF 6 one of the leading sources of anthropogenic climate change. Since SF 6 recognition as a significant contributor to climate change, most governments and organizations have sought ways to reduce or eliminate their use of this gas. Many utilities have initiated leak monitoring and repair programs which have significantly reduced emissions of this gas into the atmosphere. While leak reduction programs have been effective at reducing emission rates in the developed world, leak rates remain frozen at ~1% annually. However, one of the largest and fastest growing markets for this gas is in the developing world where emissions standards are often lacking (P&S Intelligence. 2023). To fully eliminate the environmental impacts of SF 6 , alternative technology is needed. The ideal replacement would be a technology that can fulfil the same role as SF 6 , at the same cost or cheaper, but without adverse environmental effects. Currently, no technology fits this description, however several promising technologies have begun to enter the market. This report was commissioned by the United States Department of Energy’s Office of Electricity under the Transformer Resilience and Advanced Components (TRAC) program to assess the state of industry adoption and manufacturing capability for SF 6 -free alternative technologies for use at the high-voltage level, and the primary barriers to broader adoption. While this report is tailored to the United States, the findings should be relevant to all stakeholders seeking to reduce SF 6 emissions.

24 - POWER TRANSMISSION AND DISTRIBUTION↗
DOE OSTI2025

Modelling detector-specific reconstruction uncertainties in LAr-TPC

The Short-Baseline Neutrino (SBN) program features three Liquid Argon Time Projection Chamber (LAr-TPC) detectors positioned along the Booster Neutrino Beam (BNB) axis: the Short Baseline Neutrino Near Detector, MicroBooNE, and the ICARUS T600. As the largest operational LAr-TPC, ICARUS T600 serves as the far detector, located 600 m from the BNB target. While its primary goal is to record neutrino events, it also detects other ionizing events, including cosmic rays. This work focuses on analyzing and modeling detector-specific reconstruction uncertainties in LAr-TPC. These inefficiencies, identified during the Pattern Recognition phase handled by the PANDORA algorithm, impact subsequent Particle Fits and Offline Analysis. Specifically, inaccuracies in track reconstruction can lead to significant physical consequences, such as erroneous particle energy estimates and poor Particle Identification (PID), reducing the efficiency of neutrino event characterization. A key issue addressed is split tracks, caused by missing hits or incomplete track stitching by PANDORA. The aim of this internship is to characterize, model, and quantify the impact of split tracks on track reconstruction.

43 PARTICLE ACCELERATORS↗
DOE OSTI2025

Improving ICARUS Track Reconstruction Algorithms

The ICARUS experiment is part of the Short-Baseline Neutrino (SBN) program at Fermilab. The main goal of the experiment is to investigate the possibility of sterile neutrinos in the O(1 eV) mass region and provide clarification of the anomaly detected from the Liquid Scintillator Neutrino Detector (LSND) and MiniBooNE experiments. The ICARUS-T600 detector is a Liquid Argon Time Projection Chamber (LAr-TPC), that can provide excellent 3D imaging and calorimetric reconstruction of any ionizing particles. This detection technique allows a detailed study of neutrino interactions, spanning a wide energy spectrum (from a few keV to several hundreds of GeV). The detector consists of two identical adjacent modules, filled with a total of 760 tons of ultra-pure liquid argon. Each module houses two LAr-TPCs separated by a common cathode with a maximum drift distance of 1.5 m, equivalent to about 1 ms drift time for the nominal $500$ V/m electric drift field. The anode is made of three parallel wire planes positioned 3 mm apart, where the stainless-steel wires are oriented on each plane at a different angle with respect to the horizontal direction ($+60^\degree$,$-60^\degree$,$0^\degree$). The first two planes (Induction 1 and Induction 2) provide a non-destructive charge measurement, whereas the ionization charge is fully collected by the last collection plane. In total, 53248 wires with a 3 mm pitch and length up to 9 m are installed in the detector. In the first stage of the reconstruction, segments of waveforms corresponding to physical signals (hits) are searched for in the deconvolved wire waveform with a threshold-based hit-finding algorithm. Each hit is then fitted with a Gaussian, whose area is proportional to the number of drift electrons generating the signal. In the second stage of the reconstruction, hits are passed as input to Pandora, a framework software composed of different pattern recognition algorithms, that performs a 3D reconstruction of the full image recorded in the collected event, including the identification of interaction vertices and tracks and showers inside the TPC. These are organized into a hierarchical structure (called slice) of particles generated starting from a primary interaction vertex. In some cases, related to the inefficiencies in the hit detection or excessive deflection of the particle trajectory, Pandora breaks the particle's track into two or more smaller pieces and considers each piece as an independent track. We studied this phenomenon focusing on primary muons from ν_μ CC interactions contained in a single module with a track at least 20 cm long, to exclude delta rays. The study determined that about $7-8\%$ of the muon tracks are broken. Approximately $80\%$ of the times, Pandora assigns all segments of the track to the same slice (intra-slice track split), while in the remaining $20\%$ of the cases, one of the segments is associated with another slice (extra-slice track split). To mitigate this phenomenon, we designed an algorithm that detects and stitches the tracks broken by Pandora for the intra-slice split. In Monte Carlo simulations, the algorithm showed an efficiency exceeding $80\%$ and a purity exceeding $93\%$.

Ricci, Alessandro Maria [Pisa U.; INFN, Pisa] (ORC↗
DOE OSTI2026

Interactions between molecular-scale biogeochemical processes and hyporheic exchange for understanding coupled Fe-S-C cycling in iron-rich riparian wetlands (Final Technical Report)

Riparian wetlands are dynamic interfaces that exert strong control over water quality, contaminant mobility, and greenhouse gas emissions. These systems are characterized by hyporheic exchange between oxic surface water and anoxic groundwater, which generates steep redox gradients and promotes spatially and temporally variable microbial activity. Despite growing recognition of tightly coupled iron (Fe), sulfur (S), and carbon (C) cycling in these environments, the mechanisms governing these interactions—particularly under low-sulfate freshwater conditions—remain poorly constrained. This project developed a mechanistic understanding of how hydrologic variability and microbial processes interact to control Fe–S–C cycling in iron-rich riparian wetlands. Using a multi-scale and multi-method approach integrating field observations, geochemical and spectroscopic analyses, metagenomics, and reactive transport modeling, we demonstrate that “cryptic” sulfur cycling—rapid sulfur transformations involving intermediate-valence species—plays a dominant and previously underrecognized role in freshwater wetlands. These processes persist despite low sulfate concentrations and significantly influence iron reduction, carbon mineralization, and methane dynamics. The results show that cryptic sulfur cycling enhances dissolved Fe 2+ production, regulates methane concentrations, and is strongly controlled by climate-driven hydrologic fluxes. By linking hydroclimate, subsurface flow, and biogeochemical reactions, this work provides a predictive framework for understanding how wetland systems respond to environmental change, with direct implications for water quality and carbon cycling.

54 ENVIRONMENTAL SCIENCES↗
DOE OSTI2025

Consideration of Decabromodiphenyl Ether Flame Retardant in Thermal and Radiation Aging of Crosslinked Polyethylene Cable Insulation

Decabromodiphenyl ether (decaBDE) has been used as a flame-retardant additive in nuclear-grade electrical cable insulation. However, decaBDE has been identified as a persistent, bioaccumulative and toxic (PBT) substance, leading to regulatory scrutiny. On January 6, 2021, the Environmental Protection Agency (EPA) published a final rule to phase out decaBDE. The 2021 rule set a two-year compliance deadline for “processing and distribution in commerce of decaBDE for use in wire and cable insulation in nuclear power generation facilities.” In recognition of industry concerns following a sudden discontinuation of decaBDE-containing Class 1E wire and cable essential for nuclear power operations and the time needed for qualifying the individual components using the alternative insulation technology, an extended compliance deadline was set in the finalized amendments to the 2021 rule as published by the Environmental Appeals Board on November 12, 2024. The 2024 rule set the compliance deadline for processing and distributing decaBDE-containing wire and cable insulation until the end of the service life of these materials. Since decaBDE has long been relied upon as the flame retardant in one of the most common cross-linked polyethylene (XLPE) nuclear cable insulation formulations, RSCC Firewall III insulation, questions have naturally arisen regarding whether changes in cable performance might be expected for XLPE containing a decaBDE alternative, especially for safety-related cables that must perform their safety function in a design basis event such as a loss of coolant accident.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗
DOE OSTI2026

Aggregation and Grid Security Workshop Report

The Aggregation and Grid Security Workshop - held on June 17-18, 2025, National Laboratory of the Rockies (NLR) in Golden, Colorado - brought together approximately 40 external stakeholders from the energy sector, including VPP owner/operators, aggregators, OEMs, utilities, testing & certification labs, trade associations, and cybersecurity vendors. Led by key facilitators, the workshop focused on addressing cybersecurity challenges and enhancing grid resilience for aggregated Distributed Energy Resources (DERs) and Virtual Power Plants (VPPs). The workshop was catalyzed by recognition that traditional, rearward-looking regulatory frameworks are insufficient to keep pace with technological change. There is a "missing understanding" of risk, an "absent security basis" for managing it, and an "untenable responsibility" due to unclear ownership and requirements. The workshop aimed to shift the mindset from reacting to past crises to proactively preparing for emerging threats, fostering forward resilience through risk simulation and collaborative action. This report summarizes the outcomes of the workshop, marking it a significant step toward a secure, reliable and affordable energy future.

14 SOLAR ENERGY↗
DOE OSTI2026

Cybersecurity Workforce Training for SMR Integration into Distribution Grids: A Competency Framework and Containerized Hands-On Lab for the SMR/DER/Microgrid Boundary

Small modular reactors (SMRs) and microreactors are entering the U.S. distribution grid as synchronous generation on feeders designed for loads and inverter-based distributed energy resources (DERs). No existing cybersecurity training program addresses this intersection of nuclear operations, DER management, and operational technology security. As subcontractor to Iowa State University on the CyDERMS Center, Argonne analyzed the relevant standards and training landscape, translated the resulting gaps into a twelve-objective competency framework across distribution-operator and graduate-analyst role tracks, and built a containerized training lab using a ∼400-bus composite grid model behind a realistically simulated Modbus TCP SCADA stack. The analysis isolates the balance-of-plant / energy-management-system (BOP/EMS) boundary as the critical jurisdictional seam where, as of March 2026, neither NRC nor NERC CIP cleanly claims cybersecurity responsibility for distribution-connected SMRs. The framework maps each objective across NIST CSF 2.0, ISA/IEC 62443, NIST NICE Task–Knowledge–Skill statements, and NRC RG 5.71 awareness-and-training controls. The training lab implements operator-recognition assessment scenarios spanning grid-side disturbances and telemetry-layer anomalies.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗
DOE OSTI2026

Examples of State and Utility Actions on Proactive Planning and Investments

As states across the U.S. confront rising electricity demand, clean energy deployment, grid modernization imperatives, and the integration of large new loads, some regulators and utilities are shifting away from reactive, “just-in-time” investment approaches toward more proactive planning and investment frameworks. This report compiles examples of jurisdictional and utility actions that reshape planning processes, cost recovery mechanisms, and performance oversight to anticipate—rather than simply respond to—future grid needs. Several themes emerge from state actions examined in this report. First, legislatures and commissions are increasingly directing utilities to proactively upgrade their distribution and transmission systems, reflecting a shift toward a forward-looking system that aligns planning with state policy goals. Second, states are establishing long-term, iterative planning frameworks that often feature multi-year horizons, biannual or annual compliance reporting, structured opportunities for stakeholder engagement, and emphasis on collaboration among utilities, regulators, and stakeholders. Third, states are actively investigating innovative cost recovery mechanisms designed to support accelerated electrification and grid modernization, while balancing consumer advocates’ concerns regarding the ratepayer financial risks of premature investments. Fourth, performance metrics and reporting requirements are being developed to ensure transparency and accountability for proactive investments. Fifth, methodological improvements in planning—such as aligning load forecasting assumptions, incorporating sensitivities, and considering load management potential across building, vehicles, storage, and demand response—are recurring areas of stakeholder focus across jurisdictions. Overall, these developments signify a growing recognition among state regulators, utilities, and stakeholders that proactive planning—supported by clear definitions, consistent and transparent methodologies, robust performance metrics, and innovative cost recovery mechanisms—is a tool that can be used to address the scale and urgency of contemporary grid needs.

electricity market↗
DOE OSTI2025

Nucleic Acid-Based Detection Protease Activity

Proteases include clinically relevant markers for clotting disorders, certain cancers as well as toxins. Assays for protease activity often use designed peptides mimicking natural substrates and detection with colorometric and fluorescence-based detection that is difficult to multiplex without expensive and resource demanding instruments. This work demonstrates detection of proteolytic activity using PCR and sequencing-readable reporter molecules. The assay development focused on binding the constructed peptide-oligonucleotide chimera to immobilized streptavidin. Thrombin, an essential component of the clotting cascade, was used as a model system for testing peptide substrate recognition and release of a designed oligonucleotide for detection. Detection of protease activity was demonstrated in a concentration-dependent manner using MALDI-MS, RT-PCR and DNA sequencing.

Wunschel, David S [Pacific Northwest National Labo↗
DOE OSTI2025

A standards perspective on genomic data reusability and reproducibility

Genomic and metagenomic sequence data provides an unprecedented ability to re-examine findings, offering a transformative potential for advancing research, developing computational tools, enhancing clinical applications, and fostering scientific collaboration. However, effective and ethical reuse of genomics data is hampered by numerous technical and social challenges. The International Microbiome and Multi’Omics Standards Alliance (IMMSA, https://www.microbialstandards.org/) and the Genomic Standards Consortium (GSC, https://gensc.org) hosted a 5-part seminar series “A Year of Data Reuse” in 2024 to explore challenges and opportunities of data reuse and reproducibility across disparate domains of the genomic sciences. Addressing these challenges will require a multifaceted approach, including common metadata reporting, clear communication, standardized protocols, improved data management infrastructure, ethical guidelines, and collaborative policies that prioritize transparency and accessibility. We offer strategies to enable responsible and technically feasible data reuse, recognition of data reproducibility challenges, and emphasizing the importance of cross-disciplinary efforts in the pursuit of open science and data-driven innovation.

59 BASIC BIOLOGICAL SCIENCES↗
DOE OSTI2025

Feed status and skin injury modulate immunopathology, global gene expression, and survival in channel catfish during virulent Aeromonas hydrophila infection

Introduction VirulentAeromonas hydrophilais a major pathogen in channel catfish (Ictalurus punctatus), that causes motileAeromonassepticemia and significant economic losses. We investigated the effect of feeding status and skin integrity on the host immune response, disease survival, and gastrointestinal pathology following a vAh challenge. Methods Using a bath immersion model, channel catfish were divided into four treatment groups: fin clipped and fed (FCF), fin clipped but not fed (FCN), not fin clipped but fed (NCF), and not fin clipped nor fed (NCN) alongside non-challenged control groups The FCF and NCF groups were fed 2 h prior to the challenge, but the FCN and NCN groups were not. Survival analysis, histopathological assessment, and RNA sequencing were conducted across groups at different time intervals throughout the vAh challenge. Results Survival rates were lowest in the FCF and FCN groups (30% and 23% survival, respectively), suggesting that both feeding and skin damage contributed to disease severity. Histopathological analyses revealed more severe intestinal and gastric lesions in fed groups, characterized by epithelial necrosis, hemorrhage, and edema. Transcriptomic analysis among the groups identified significant differentially expressed genes associated with inflammation, apoptosis, and metabolic stress, with notable upregulation of interleukin 1-beta (il-1β), and complement C3 (c3). Gene ontology enrichment highlighted distinct immune activation patterns between fed and unfed groups, with enhanced pathogen recognition and pro-inflammatory responses in unfed fish. Discussion These findings suggest feeding prior to infection may exacerbate disease pathology, potentially by creating a physiological state conducive to facilitate pathogen proliferation and dampened early immune responses, whereas short-term fasting appears to promote early immune activation. This study provides novel insights into the complex interplay between feed status, physical injury, and immune response to vAh infection.

Immunology↗
DOE OSTI2025

Case Report: Differential diagnosis of hematuria in the emergency department: emphasizing double J stent-inferior vena cava fistula

Introduction Hematuria, a common clinical indicator of genitourinary tract pathology, arises from diverse etiologies including calculi, infections, malignancies, trauma, and iatrogenic causes. Initial evaluation requires hemodynamic assessment, identification of underlying causes, and urinary drainage optimization. This report highlights a rare case of iatrogenic hematuria secondary to double-J stent migration into the inferior vena cava. Case presentation A Chinese male presented with acute left flank pain and gross hematuria persisting for 4 h. Diagnostic imaging revealed a left ureteral stone, prompting double-J stent placement at a local hospital. Despite intervention, hematuria worsened, necessitating abdominal CT. Imaging identified proximal migration of the left double-J stent into the inferior vena cava, with no evidence of vascular injury. Due to concerns regarding inadequate drainage and infection risk, conservative management without catheter clamping was initiated prior to referral. Definitive treatment involved ureteroscopic stent removal under direct visualization at our institution, resulting in rapid symptom resolution. Conclusion This case emphasizes three critical clinical insights: (1) Persistent postoperative hematuria warrants consideration of iatrogenic causes, particularly following urologic device placement. (2) Imaging modalities, especially CT, are indispensable for detecting atypical stent migration. (3) Comprehensive history-taking must include prior urologic interventions to guide differential diagnosis. While double-J stent migration into major vessels remains exceptionally rare, its recognition prevents delayed management of potentially life-threatening complications. Clinicians should maintain heightened vigilance for device-related hematuria in patients with refractory symptoms post-procedurally, ensuring prompt imaging evaluation and multidisciplinary intervention when indicated.

Qi, Wenqi↗