Figure 1
Control Film of an Intravenous Urogram (IVU)
This preliminary radiograph of an IVU shows radiodense opacity within the left renal outline suggestive of a renal calculus.
Pyeloureteritis Cystica
SectionUroradiology & genital male imaging
Case TypeClinical Cases
Authors
Prapul Rajendran1, Ramakrishna Kishore2, Raghuram Sathyanarayana1
1 Royal Victoria Hospital, Belfast, Northern Ireland
2 University Hospital of Wales, Cardiff, Wales
Connected authors
60 years, female
Clinical History
A 60-year-old lady with a history of type 2 diabetes mellitus was referred by a urologist for an intravenous urogram (IVU) due to a recent onset of microscopic haematuria.
Imaging Findings
The IVU revealed a non obstructing calculus in the lower pole of the left kidney. In addition, there were several rounded filling defects seen through out the ureter. The papillae of the left kidney showed rounded appearance suggestive of papillary necrosis, a sequel of diabetes. There was no delay in excretion of contrast and the IVU was otherwise unremarkable. Appearances were felt to be typical of pyeloureteritis cystica.
Discussion
Pyeoloureteritis cystica is a condition with multiple small suburoepithelial cysts in the renal pelvis and ureter, believed to arise by proliferation of the surface epithelial cells resulting in the formation of fluid-filled cysts. It is usually seen in the setting of chronic obstruction or infection. The organisms frequently involved are E. coli, M. tuberculosis, Enterococcus and Proteus. This condition is more commonly seen in diabetics and prevalent in middle aged females. They are predominanly seen in the bladder followed by proximal 1/3 of ureter and ureteropelvic junction. It is usually unilateral.
Gross examination reveals small, discrete translucent, grayish, cystic bodies, commonly located in the trigone and vicinity of the ureteral orifices.
They can persist unchanged for years in spite of antibiotic treatment. The differential diagnosis includes multifocal transitional cell carcinomas, clots, calculi and vascular scalloping secondary to hypertrophy of the gonadal veins.
Gross examination reveals small, discrete translucent, grayish, cystic bodies, commonly located in the trigone and vicinity of the ureteral orifices.
They can persist unchanged for years in spite of antibiotic treatment. The differential diagnosis includes multifocal transitional cell carcinomas, clots, calculi and vascular scalloping secondary to hypertrophy of the gonadal veins.
Differential Diagnosis List
Pyeloureteritis Cystica
Final Diagnosis
Pyeloureteritis Cystica
References
[1] Grainger RG, Allison DJ, Adam A, Dixon AK (2003) Grainger and Allisons Diagnostic radiology, 4th Edition, Volume 2, 1553-1554.
[2]
Witten DM, Meyers GH, Utz DC. Emmets Clinical Urography.
W. B. Saunders Company. Philadelphia 1977:873-876.
Case information
| URL: | https://www.eurorad.org/case/7199 |
| DOI: | 10.1594/EURORAD/CASE.7199 |
| ISSN: | 1563-4086 |
Figure 2
Excretory Urogram obtained 5 minutes following IV contrast
Symmetrical excretion of contrast is seen bilaterally. Several rounded filling defects are seen mostly in the lower third of the left ureter.
Figure 3
Excretory Urogram obtained at 15 minutes following IV contrast
Several rounded filling defects are noted in the proximal and distal third of the left uereter. Appearances are typical of pyeloureteritis cystica. Also note the appearance of the papillae of the left kidney.
Figure 4
Post micturition Urogram
Post micturition urogram shows reasonable clearance of contrast bilaterally and there is no evidence of obstruction.
Control Film of an Intravenous Urogram (IVU)
This preliminary radiograph of an IVU shows radiodense opacity within the left renal outline suggestive of a renal calculus.
Excretory Urogram obtained 5 minutes following IV contrast
Symmetrical excretion of contrast is seen bilaterally. Several rounded filling defects are seen mostly in the lower third of the left ureter.
Excretory Urogram obtained at 15 minutes following IV contrast
Several rounded filling defects are noted in the proximal and distal third of the left uereter. Appearances are typical of pyeloureteritis cystica. Also note the appearance of the papillae of the left kidney.
Post micturition Urogram
Post micturition urogram shows reasonable clearance of contrast bilaterally and there is no evidence of obstruction.