Presentation
Antenatal scan on 28 week of gestation.
Patient Data
Male fetus with bilateral marked dilatation of pelvicalyceal systems.
right kidney measures 5.3 x 2.4 cm, renal pelvis AP diameter 23 mm
left kidney measures 7.2 x 4 cm, renal pelvis AP diameter 36 mm
Urinary bladder is present with average size. There are tubular structures behind urinary bladder may represent dilated ureters.
Polyhydramnios was noted (AFI=24).
Case Discussion
Fetal hydronephrosis is one of the common fetal urogenital anomalies, that is easily identified on antenatal scan. In third trimester, if measurement of AP diameter of renal pelvis exceeds 10 mm it is considered persistent hydronephrosis.
There are multiple pathologies that present with pelvicalyceal dilatation, of these we raised the possibility of:
bilateral vesicoureteric reflux: high grade due to dilatation of pelvicalyceal system
bilateral pelviureteric junction obstruction: the most commonest cause but they are not associated with dilated ureters. It is more common in males
posterior urethral valve: common in males and shows dilated urinary bladder with keyhole appearance of bladder outlet which is not present
The presence of normal or increased amount of liquor has a better prognosis than oligohydramnios. Postnatal ultrasound was recommended for further assessment.
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