PEDIATRIC RADIOLOGY: Genitourinary Radiology
Case Author: Krista L. Birkemeier, MD, Cincinnati Children’s Hospital Medical Center
History
1-day-old boy with prenatally diagnosed right multicystic dysplastic kidney and left hydronephrosis
Imaging Findings
Longitudinal ultrasound image of the left kidney (A) shows moderate pelvocaliectasis.
Transverse ultrasound image of the left proximal ureter (B) shows ureteral dilatation (arrow).
Longitudinal ultrasound image of the left distal ureter and bladder (BL) (C) shows a dilated ureter (arrows) that tapers to insert in its orthotopic location into the bladder. The bladder wall was incompletely evaluated because the bladder is not distended.
Diagnosis
Ureterovesical obstruction
Teaching Points
In an infant boy, posterior urethral valves is the primary cause of bladder outlet obstruction. Voiding cystourethrography is the next appropriate study for evaluation of infants with suspected posterior urethral valves.
Ureterovesical junction obstruction can be primary anatomic obstruction (ureterocele, ectopic insertion), primary functional obstruction (primary megaureter), or a condition secondary to a ureteral stone, pelvic or bladder mass, or trauma. The degree of obstruction is assessed with furosemide renography, and the decision for surgical intervention depends on the degree of obstruction, presence of symptoms or recurrent infection, and renal function.
Vesicoureteral reflux can cause hydroureteronephrosis and is associated with contralateral multicystic dysplastic kidney. Voiding cystourethrography is the next appropriate study for evaluation of infants with suspected vesicoureteral reflux.
Suggested Readings
Riccabona M. Obstructive diseases of the urinary tract in children: lessons from the last 15 years. Pediatr Radiol 2010; 40:947–955
Slovis TL, Adler BH, Bloom DA, et al. Caffey’s pediatric diagnostic imaging, 11th ed. Philadelphia, PA: Mosby, 2008
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