EURORAD ESR

Case 1932

Role of multidetector row CT in preoperative assessment of patients with ureteropelvic junction obstruction

Author(s)
T .A. El-Diasty, A.R. El-Nahas, M.E. Abou-Elghar
 
 
  • Figure 1
    Ultrasonography of the left kidney

    Abdominal ultrasound revealed moderate hydronephrotic changes of the left kidney, with preserved parenchymal thickness and a ballooned anteriorly malrotated renal pelvis.

     
    Area of Interest: unknown; Imaging Technique: Ultrasonography of the left kidney;
     
     
  • Figure 2
    Contrast study of the left kidney
     

    Intravenous urography (via the IVC) showed a ballooned, malrotated renal pelvis; grade II hydronephrosis and a non-visualised left ureter.

     
    Area of Interest: unknown; Imaging Technique: Contrast study of the left kidney;

    Retrograde study of the left kidney confirmed the level of obstruction at the UPJ.

     
    Area of Interest: unknown; Imaging Technique: Contrast study of the left kidney;
     
     
  • Figure 3
    Renal scintigraphy
     

    MAG3 renal scintigraphy demonstrated the obstructed left kidney at the level of the ureteropelvic junction (UPJ) with 28ml/min renographic clearance, which represented 38% of the total renal function.

     
    Area of Interest: unknown; Imaging Technique: Renal scintigraphy;

    Obstructed curve of the left kidney, with no response to diuresis.

     
    Area of Interest: unknown; Imaging Technique: Renal scintigraphy;
     
     
  • Figure 4
    CT angiography
     

    On coronal reformatted maximum intensity projection, two vessels, artery and vein, were seen crossing medial and anterior to the UPJ. Their diameters were 3.5 mm and 7.7mm respectively. The artery was a branch of the...

     
    Area of Interest: unknown; Imaging Technique: CT angiography;

    Axial CT at the level of the left renal hilum showed the crossing artery and vein.

     
    Area of Interest: unknown; Imaging Technique: CT angiography;
     
     
  • Figure 5
    CT angiography

    Compression of the left renal vein between the aorta and the superior mesentric artery with dilated renal vein and collaterals at the hilum.

     
    Area of Interest: unknown; Imaging Technique: CT angiography;
     
     
  • Figure 6
    Intravenous urography

    IVU revealed grade 3 hydronephrosis, a ballooned renal pelvis and double bubble sign at the UPJ, suggesting a crossing vessel,

     
    Area of Interest: unknown; Imaging Technique: Intravenous urography;
     
     
  • Figure 7
    Renal scintigraphy
     

    The renographic clearance was 34ml/min (35% of the total clearance). Dynamic scannning with 99mTc-MAG3 showed no response to lasix.

     
    Area of Interest: unknown; Imaging Technique: Renal scintigraphy;

    Obstructed pelvigram of the right kidney with non-visualised ureter.

     
    Area of Interest: unknown; Imaging Technique: Renal scintigraphy;
     
     
  • Figure 8
    CT angiography
     

    Arterial phase scan showed a crossing artery at the UPJ. The diameter of the artery was 3mm.

     
    Area of Interest: unknown; Imaging Technique: CT angiography;

    Venous phase scan showed a crossing vein, 8.7mm in diameter, at the UPJ.

     
    Area of Interest: unknown; Imaging Technique: CT angiography;
     
     
Abdominal ultrasound revealed moderate hydronephrotic changes of the left kidney, with preserved parenchymal thickness and a ballooned anteriorly malrotated renal pelvis.
 
Intravenous urography (via the IVC) showed a ballooned, malrotated renal pelvis; grade II hydronephrosis and a non-visualised left ureter.
 
Retrograde study of the left kidney confirmed the level of obstruction at the UPJ.
 
MAG3 renal scintigraphy demonstrated the obstructed left kidney at the level of the ureteropelvic junction (UPJ) with 28ml/min renographic clearance, which represented 38% of the total renal function.
 
Obstructed curve of the left kidney, with no response to diuresis.
 
On coronal reformatted maximum intensity projection, two vessels, artery and vein, were seen crossing medial and anterior to the UPJ. Their diameters were 3.5 mm and 7.7mm respectively. The artery was a branch of the main renal artery and the vein was a tributary of the main renal vein.
 
Axial CT at the level of the left renal hilum showed the crossing artery and vein.
 
Compression of the left renal vein between the aorta and the superior mesentric artery with dilated renal vein and collaterals at the hilum.
 
IVU revealed grade 3 hydronephrosis, a ballooned renal pelvis and double bubble sign at the UPJ, suggesting a crossing vessel,
 
The renographic clearance was 34ml/min (35% of the total clearance). Dynamic scannning with 99mTc-MAG3 showed no response to lasix.
 
Obstructed pelvigram of the right kidney with non-visualised ureter.
 
Arterial phase scan showed a crossing artery at the UPJ. The diameter of the artery was 3mm.
 
Venous phase scan showed a crossing vein, 8.7mm in diameter, at the UPJ.
 
 
 
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