Clinical History
consulted for general malaise, frequent microscopic hematuria, and mild proteinuria.
The patient’s history was irrelevant, except for slight prostatic hypertrophy. Physical examination was normal. Laboratory blood tests disclosed an increased sedimentation rate and moderate leucocytosis.
Imaging Findings
A patient man consulted for general malaise, frequent microscopic hematuria, and mild proteinuria.
The patient’s history was irrelevant, except for slight prostatic hypertrophy. Physical examination was normal. Laboratory blood tests disclosed an increased sedimentation rate and moderate leucocytosis.
Intravenous urography (IVU) includes 5 and 10 minute films of kidneys and ureters during excretion and a detailed view of the right ureter on 20 minute IVU film following abdominal decompression .
All films during the course of the examination demonstrate a normal appearance of the pyelocaliceal system of both kidneys. Multiple, small ureteral outpouchings are observed along the course of both ureters. These, however, are most prominent in the upper part of the right ureter.
After decompression delayed emptying of these outpouchings is noticed .
The radiological findings on IVU are virtually diagnostic for ureteral pseudodiverticulosis.
Discussion
The spectrum of responses of the ureter to inflammatory stimuli is rather narrow. In rare cases inflammation may lead to ureteral pseudo-diverticulosis. At present, both etiology and microscopic anatomy of this condition are not fully elaborated due to scarcity of material.
Fine mucosal irregularity is seen in any type of acute urinary tract inflammation. It is caused by subepithelial leucocytic infiltration and mucosal edema.
Chronic conditions in which amyloid deposition occurs in the same layers, cause a coarser irregularity of the ureteral wall, which may resemble malignancy. Ureteris cystica and profunda has been shown to be capable of distorting the ureteral folds and cause undulating contours with small outpouchings of less than 4 mm in size. These are called pseudodiverticula. This phenomenon is associated with hyperplasia of the transitional epithelium, forming glands of Brunn. When the intra-mural process extends and becomes macroscopically visible, pseudopolypoid filling defects, representing fluid-filled subepithelial cysts, can be observed on urography.
Actually a macroscopically visible pseudodiverticulum represents a downward proliferation of the lamina propria into the loose connective tissue. Studies on surgical specimens revealed that the pseudodiverticula contain all of the muscle layers of the normal ureter.
Patients with ureteral pseudodiverticula have symptoms of urinary tract infection and often hematuria. Most cases reported in the literature concern males between 40 to 85 years of age. Male to female ratio is 6: 1. The radiological appearance of pseudodiverticulosis is characteristic. The pseudodiverticula present a multiple, small (2-4 mm in diame-ter), contrast-filled pouches in the wall of the proximal or middle ureter. Visualization is better on antegrade or retrograde reterography than on IVU. The ureteral pseudodiverticula can easily be differentiated from true or false ureteral diverticula. The latter are usually single, unilateral and larger than 5 mm in diameter.
Differential Diagnosis List
Ureteral pseudodiverticulosis
Final Diagnosis
Ureteral pseudodiverticulosis
