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Pelvic kidney with ureterocele

Case contributed by Ahmed D. Abdulwahab
Diagnosis certain

Presentation

Recurrent urinary tract infection

Patient Data

Age: 9 years
Gender: Male

Intravenous urography

x-ray

On the plain image, normal radiopaque shadows are seen along the course of the urinary tract.

After contrast injection, the right kidney appears malrotated but in normal anatomical position. 

The left kidney is seen in the left side of the pelvis (left pelvic kidney), it also appears malrotated, there is a focal dilatation seen at the distal aspect of the left ureter just proximal to the ureterovesical junction, this dilatation appears to retain contrast on the post voiding images, findings are indicative of left pelvic kidney with left ureterocele. 

Case Discussion

Pelvic kidney is a congenital abnormality in which the kidney does not ascent into its normal anatomical position and stay within the pelvis, it is the most common form of renal ectopia, most of the times it is asymptomatic and discovered incidentally, other clinical presentations may include recurrent urinary tract infections, renal stone formation, incontinence, palpable mass and hypertension.  

Ureterocele, on the other hand, is another congenital abnormality in which there is a dilatation of the distal part of the ureter which may herniate into the urinary bladder. It is much more common in females than in males (about 5 to 6 times more common), and 10% bilateral.

Most ureteroceles are associated with ectopic insertion of the ureter in duplicated renal collecting system. it is either intravesical (less common (20%) in which the vesicoureteric junction is normal) or extravesical ( 80%) which occur in ectopic ureteric insertion usually low and medial near the bladder neck).

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