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Pelviureteric junction obstruction in horseshoe kidney

Case contributed by Jonathan A. Hernandez Mancera
Diagnosis almost certain

Presentation

History of vague daily right abdominal pain from several years. The pain had increased in severity and frequency in the past months. Also, the symptoms were more frequent after oral intake of alcohol.

Patient Data

Age: 50 years
Gender: Male

Portal venous phase shows a horseshoe kidney with severe right hydronephrosis, especially at the renal pelvis. The right ureter remains its normal caliber. There is also a mild cortical thinning of the right kidney compared to the left kidney.

Prone-axial excretory phase shows a normal left urinary tract, as well as severe right hydronephrosis. The right ureter can be seen opacified in its distal third, with a normal caliber. The findings are compatible with a right pelviureteric junction obstruction in a horseshoe kidney.

Case Discussion

After the CT scan, the patient underwent a renogram that showed signs of obstruction, with preserved kidney function. Because of the symptoms, a laparoscopic pyeloplasty was performed. Currently, there is a reduction in the hydronephrosis of the right kidney, there are no signs of obstruction in the renogram and the patient remains asymptomatic.

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