Longitudinal left kidney. Ballooning of the renal pelvis and widened calyces with maintained form between the pyelon and calyx system. Calyx necks are without a doubt open. Narrowing of the parenchyma between the calyces (urine transport defect III.°).


Megaureter, proximal.

Megaureter, retrovesical.

Hydronephrosis with megaureter at ureterostium stenosis

By PedRad


History: Clinically asymptomatic child. (In the prenatal diagnostics there was a widening of the left renal pelvis and the left ureter seen)


Findings:

Ultrasound 1: Longitudinal left kidney.  Ballooning of the renal pelvis and widened calyces with maintained form between the pyelon and calyx system.  Calyx necks are without a doubt open.  Narrowing of the parenchyma between the calyces (urine transport defect III.°). :: Ultrasound 1 ::
Longitudinal left kidney. Ballooning of the renal pelvis and widened calyces with maintained form between the pyelon and calyx system. Calyx necks are without a doubt open. Narrowing of the parenchyma between the calyces (urine transport defect III.°).










Ultrasound 2: Megaureter, proximal. :: Ultrasound 2 ::
Megaureter, proximal.









Ultrasound 3: Megaureter, retrovesical. :: Ultrasound 3 ::
Megaureter, retrovesical.









Discussion:
Due to ostium stenosis, urine blockage and by persistance irreversible pressure atrophy of the kidney parencyma.

The pressure atrophy of the parenchyma is irreversible. After treatment of the cause, usually the widening of the pyelon, the calyces and the ureter does not fully retract (persistent ectasia). The renal function can, however, be partially or completely maintained.

Article by: C. Bock (Halle), www.PedRad.info (www.pedrad.info)



Differential diagnosis: The hyrdonephrosis with megaureter (as in this case) must be differentiated from a ureter stenosis.

Without a megaureter, a ureteric stenosis (most common cause), stones, an accessory pole vessel or ureteric spasm as an intermittent hinderance of passage can be possible differential diagnoses.

Differetial diagnoses could also include polycystic kidneys, which have similar findings. The difference can be difficult, if a large cyst lies centrally or if the parynchema is so thin, that it looks similar to septae. Sonographically, the difference lies always in the connection to the cayxes and pyelon.

The miction zysto-uerterography shows no vesiculo-ureteric reflux and no subvesical obstruction, so that a diagnosis of a massive vesiculo-ureteric reflux can be discarded.

Diagnosis confirmation: Imaging including endoscopy



Category: Pediatric

Region / Organ: Abdomen-Renals

Etiology: congenital

References:




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