Case Author(s): Charles Pringle, M.D., Barry A. Siegel, M.D. , 01/10/96 . Rating: #D2, #Q3

Diagnosis: Vesicoureteral Reflux

Brief history:

Past history of colon cancer


Posterior images, 1 minute through 19 minutes after injection of Tc-99m MAG3

View main image(rs) in a separate image viewer

View second image(rs). Sequential images after administration of furosemide (Lasix).

View third image(mm). Split renal function calculation and time-activity curve

View fourth image(mm). Lasix washout curves

Full history/Diagnosis is available below

Diagnosis: Vesicoureteral Reflux

Full history:

Previous history of colon cancer approximately 12 years ago. Treatment included radiation therapy. The patient subsequently developed radiation cystitis and a small-capacity bladder. She also subsequently developed bilateral ureteral obstruction, which has been treated with bilateral ureteral stents, which are now in place.


7.3 mCi Tc-99m MAG3


There is prompt mildly asymmetric perfusion to both kidneys, with left kidney perfusion slightly less than the right. There is also prompt uptake and excretion by both kidneys, although the left renal excretion is slightly less than the right. Split renal function is 62% right kidney and 38% left kidney.

Despite the intravenous administration of furosemide, there appears to be an increase in radiopharmaceutical activity within the collecting systems of both kidneys over time. This is consistent with bilateral reflux into the ureteral stents and into the collecting systems of both kidneys. The patient's small capacity bladder also most likely contributes to this process.


Subsequent cystoscopy revealed a markedly decreased bladder capacity (75 mL total).

Major teaching point(s):

It is importance to correlate the post-diuretic washout curve with the appearance of the images. In this case, the images confirmed the vesicoureteral reflux. This is not unusual in patients with ureteral stents.

ACR Codes and Keywords:

References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Organ specific)

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Case number: rs008

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