Chronic pelviureteric junction obstruction

Case contributed by Mohamed Mahmoud Elthokapy
Diagnosis almost certain


Patient presents with sensation of a left flank mass and chronic loin pain.

Patient Data

Age: 15 years
Gender: Female

Left kidney and ureter:

  • left kidney shows markedly enlarged size measuring about (7.7 x 8 x 14.5 cm at max. AP, TV and CC dimensions respectively) moreover showing a markedly dilated pelvi-calyceal system with ballooned calyces down to pelviureteric junction where abrupt transition seen. Consequently, reduced renal parenchymal thickness  
  • left ureter is not significantly dilated
  • no left renal stones

Right kidney and ureter:

  • mild fullness of right renal collecting system and ureter likely secondary to distended urinary bladder
  • right kidney shows normal position and average size with regular contour and preserved parenchyma
  • no right renal stones
  • no back pressure changes

No radio-opaque urinary calculi or pathological calcification could be detected.

Markedly enlarged left kidney with delayed contrast excretion showing marked dilatation of the left pelvicalyceal system down to pelvi-ureteric junction where abrupt transition seen and no dilated ureter detected.

No achieved images of opacified left ureter up to 5 hours from beginning of the study.

Adequate contrast concentration and excretion by right kidney showing normal site, size and smooth outline.

Normal course and caliber of right ureter with no evidence of ureteric dilatation detected.

Normal filling and post voiding cystogram.

Case Discussion

This case demonstrates typical appearances of chronic marked left pelvi-ureteric junction obstruction, likely to be congenital.

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