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    Case of the Day
    Hydronephrosis with megaureter at ureterostium stenosis

    Modality: Ultrasound Modality: Ultrasound Modality: Ultrasound

    View here all images of this case in different sizes !

    Go to the top of the page ID: 20021002125133
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     Hydronephrosis with megaureter at ureterostium stenosis   
     Available images: There are Ultrasound images available for this case. [ Ultrasound ]   

    Carsten Bock (Halle)  

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    Clinically asymptomatic child. (In the prenatal diagnostics there was a widening of the left renal pelvis and the left ureter seen)  

     Pathomorphology or Pathophysiology of this disease :

    Due to ostium stenosis, urine blockage and by persistance irreversible pressure atrophy of the kidney parenchyma.  

     Radiological findings:

    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Longitudinal left kidney. Ballooning of the renal pelvis and widened calyces with maintained form between the pyelon and calyx system. Calyx necks are without a doubt open. Narrowing of the parenchyma between the calyces (urine transport defect III.°).

    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Megaureter, proximal.

    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Megaureter, retrovesical.


     Diagnosis confirmation:

    Imaging including endoscopy  

     Which DD would be also possible with the radiological findings:

    The hyrdonephrosis with megaureter (as in this case) must be differentiated from a ureter stenosis.

    Without a megaureter, a ureteric stenosis (most common cause), stones, an accessory pole vessel or ureteric spasm as an intermittent hinderance of passage can be possible differential diagnoses.

    Differetial diagnoses could also include polycystic kidneys, which have similar findings. The difference can be difficult, if a large cyst lies centrally or if the parynchema is so thin, that it looks similar to septae. Sonographically, the difference lies always in the connection to the cayxes and pyelon.

    The miction zysto-uerterography shows no vesiculo-ureteric reflux and no subvesical obstruction, so that a diagnosis of a massive vesiculo-ureteric reflux can be discarded.  

     Course / Prognosis / Frequency / Other :

    The pressure atrophy of the parenchyma is irreversible. After treatment of the cause, usually the widening of the pyelon, the calyces and the ureter does not fully retract (persistent ectasia). The renal function can, however, be partially or completely maintained.  

     Comments of the author about the case:


     First description / History:






     Most likely etiology:


     Available images: There are Ultrasound images available for this case. [ Ultrasound ]   
    More cases from these authors: Search Carsten Bock in Medline Carsten Bock (9)     

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