Pelviureteric junction obstruction by accessory renal vein

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Right loin pain.

Patient Data

Age: 35 years
Gender: Male

Moderate right hydronephrosis, with delayed contrast excretion compared to the left kidney.

An accessory inferior right renal vein is seen crossing anterior to the pelviureteric junction, likely the cause of obstruction.

Case Discussion

A crossing vessel at pelviureteric junction is one of the recognized causes of pelviureteric junction obstruction. Most commonly, it is caused by crossing inferior branches of renal artery rather than a crossing vein.

In this case, an accessory right inferior renal vein is crossing anterior to the pelviureteric junction with ballooning of renal pelvis proximally, mostly the cause of obstruction.

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