CASE 1333 Published on 19.11.2002

Ultrasound diagnosis of ureteral obstruction: an extrinsic compression by enlarged ovary

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

S. Kapustin

Patient

40 years, female

Categories
No Area of Interest ; Imaging Technique Ultrasound, Ultrasound
Clinical History
Regular right flank pain associated with menstrual cycle. Abdominal ultrasonography revealed a mild hydronephrosis and ureteral dilatation.
Imaging Findings
The patient, with continuous right flank pain, was admitted as anoutpatient for US abdominal examination. The pain was regular. It usually started after the middle of a menstrual cycle and resolved without any treatment. Abdominal ultrasonography was performed on the 24th day of the cycle and showed a mild right hydronephrosis (Fig. 1a). The ureter was inspected to determine the cause of hydronephrosis and an extrinsic compression of the ureter between the iliac vessels and enlarged right ovary was evidenced. The enlarged right ovary included a corpus luteum cyst (Fig. 1b). There were no other causes of ureteral obstruction detected. Hormonal therapy was administered. One month later the patient was examined again, she had neither pain nor complaints. Urinalyses were normal and there no stone passage was evidenced during the follow-up period. Abdominal ultrasonography showed no signs of hydronephrosis (Fig. 2a). The right ovary size was normal and remnants of the corpus luteum cyst were seen (Fig. 2b).
Discussion
A great variety of pathological lesions may obstruct the ureters and give rise to hydroureter and hydronephrosis. Causes are grouped into those of intrinsic origin and those of extrinsic origin. One of the extrinsic causes is compressing of an ureter result of ovary enlargement. Screening of obstruction is most efficaciously performed with ultrasonography, but accurate diagnosis is normally based on combining information from ultrasonography, plain radiographs and intravenous pyelography. Usually, ultrasonography is used for hydronephrosis detection, but this case shows ability of the method to determine the cause of ureteral obstruction.
Differential Diagnosis List
Right ureterohydronephrosis
Final Diagnosis
Right ureterohydronephrosis
Case information
URL: https://www.eurorad.org/case/1333
DOI: 10.1594/EURORAD/CASE.1333
ISSN: 1563-4086