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This case shows severe hydronephrosis with thinned parenchyma (grade III), with a markedly dilated pelvicalyceal system.
The upper ureter is tortuous and hooked around accessory renal vessels that reaches a cystic structure at left lumbar region with the same appearance of the obstructed kidney with thinned cortex, suggestive of an accessory obstructed kidney.
There is a linear hyperdense left pelvic structure near the left pelviureteric junction that could represent a stone or phlebolith.