Presentation
Right loin pain.
Patient Data
Duplex configuration of the right renal collecting system. The middle and lower calyces are moderately dilated with ballooned renal pelvis and abrupt termination at the vesicoureteric junction point. Absent distal dilated lower moiety ureter. The renal parenchyma of the lower moiety is thinned with delayed enhancement and excretion compared to the upper moiety by the effect of the obstruction.
The unobstructed upper moiety calyceal system is patent and continues with the right ureter till its normal vesicoureteric junction. The upper moiety parenchyma matches the enhancement and excretion pattern of the left kidney with no evidence of obstruction.
Bilateral accessory renal artery that originates from the aorta just below each renal artery.
Case Discussion
Radiological features are in favor of pelviureteric junction obstruction of the lower moiety pelvicalyceal system of the right kidney, a type of duplication with a single ureter and the obstruction is likely due to stricture at the uniting point of the two moieties at the pelviureteric junction.
Accessory renal artery in this case is a possible cause of the pelviureteric junction obstruction of the obstructed right renal lower moiety.
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