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Patient: 1 month 13 day old |
History: 44-day-old baby boy with right hydronephrosis and hydroureter. |
Image Size:[small][as-submitted]
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Findings: Diuretic renal scintigraphy was performed (1.2 mCi Tc-99m MAG3 i.v. and 5 mg furosemide i.v.). The posterior abdominal radionuclide angiogram demonstrates normal, symmetrical perfusion of the kidneys (figure 1). After 20 minutes of imaging, there is a small amount of retained activity in the left collecting system, which appears normal in size. There is a moderate amount of retained activity in the right collecting system, which appears moderately enlarged. There is faint tracer activity in the dilated right renal pelvis and proximal ureter. The left ureter appears normal. The right ureter appears tortuous and dilated. The bladder appears normal (figure 2). To evaluate for obstruction, the patient was given furosemide. Sequential images were obtained for an additional 20 minutes with the patient in the supine position. There is prompt clearance of pelvicalyceal activity on the left after diuretic administration. On the right, there is also prompt clearance of activity from the pelvicalyceal system (figure 3). After diuretic administration, the half-time of tracer clearance from the left kidney was not calculated since there was no residual tracer activity in the renal collecting system. The half-time of tracer clearance from the right kidney is 7 minutes and from the right dilated ureter is 7 minutes (figure 4). The patient had a renal sonogram that demonstrated moderate to severe right hydronephrosis and hydroureter (figure 5), and a voiding cystourethrography study was normal without evidence of vesicoureteral reflux (figure 6). |
DDx: Differential Diagnosis: 1. Congenital Megaureter 2. Vesicoureteral reflux 3. Duplex collecting system. |
Diagnosis: Diagnosis: Non-refluxing unobstructed primary megaureter |
References: The Diagnosis and Treatment for Primary Obstructive Megaureter in Adult and Children-Three Cases Experience and Review of the Literatures; Siu-San Tse, Jue-Hawn Yin; JTUA (2009) 20:173-7. Education article: Primary non-refluxing megaureters; E. Merlini, P. Spina; "Journal of Pediatric Urology" (2005) 1, 409-417. http://www.uptodate.com/contents/primary-megaureter-in-infants-and-children |
Comments: No comments posted. |
Additional Details:
Case Number: 446205Owner(s): Keith Fischer and Rosana PonisioLast Updated: 02-07-2013 The reader is fully responsible for confirming the accuracy of this content. |