CASE 14220 Published on 14.12.2016

Retrocaval ureter: a congenital cause of right ureteral obstruction

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

Joao Araujo, Carlos Macedo, Filipa Vilas Boas, Ana Alves, Joao Amorim, Raquel Maia

rua Professor Rodolfo Abreu, N299, Hab C63 4150-637 Porto, Portugal; Email:joaoaraujo.rad@gmail.com
Patient

19 years, female

Categories
Area of Interest Kidney, Urinary Tract / Bladder ; Imaging Technique CT, Ultrasound
Clinical History
We present a case report of a woman with lumbar pain and macroscopic hematuria.
Imaging Findings
The proximal ureter courses posterior to the IVC and then emerges on the right side of the aorta and continues anterior to the right iliac vessels. CT and ultrasound are the main techniques used to study patients with these clinical symptoms, particularly the ultrasound which will easily show a right hydroureteronephrosis.
CT usually permits additional characterization and proximal hydroureteronephrosis is easily identified. The abnormal position of the ureter in relation to the inferior vena cava is sometimes difficult to be detected. The accuracy of the study is improved with the late excretory phase, which allows identification of an opacified ureter. The right ureter’s course swings medially and passes behind the IVC by the inferior level of L3. It then exits anteriorly, between the IVC and the aorta, returning to its normal position.
Discussion
A circumcaval ureter, also known as retrocaval ureter, is the result of an abnormal development of the inferior vena cava (IVC) and the ureter. The IVC develops ventral of the right ureter due to the persistence of the right subcardinal vein in the lumbar area [1].

Retrocaval ureter is a rare congenital abnormality [2] associated with right side hydroureteronephrosis. It usually has a S-shape that is due to the passage of the ureter posteriorly to the inferior vena cava (IVC). Although extremely rare, retrocaval ureter is the most common congenital venous anormaly that results in the obstruction of the ureter. Although congenital, some patients will only become symptomatic by the 3rd or 4th decade of life [2].
The typical symptoms are the lumbar pain, recurrent urinary tract infections due to urinary stasis, hematuria and kidney insufficiency.
The radiologic imaging plays a crucial role in their diagnosis.
The choice of surgical approach depends on the grade of the hydroureteronephrosis.
Differential Diagnosis List
Hydroureteronephrosis associated with retrocaval ureter
Retroperitoneal fibrosis
Retroperitoneal mass
Stone
Final Diagnosis
Hydroureteronephrosis associated with retrocaval ureter
Case information
URL: https://www.eurorad.org/case/14220
DOI: 10.1594/EURORAD/CASE.14220
ISSN: 1563-4086
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