Presentation
Left flank pain
Patient Data
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.
Case Discussion
The left lumbar cystic structure is suggestive of an accessory kidney with obstructed pelvicalyceal system as the left kidney. This could be associated with ureteric anomalies as ectopic ureteric opening and fusion anomalies as causes of obstruction. Ureteric strictures and pelviureteric junction obstruction also can result from recurrent urinary tract infections that associate ureteric anomalies.
The certain cause of obstruction is not known as the delayed excretory phase is not available.
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