Pelviureteric junction obstruction with aberrant accessory lower pole renal artery

Case contributed by Dr Pavel Nikolaev

Presentation

History of hydronephrosis, associated with ureterovascular conflict. Operated 7 months ago - plasty of pelvi-ureteric junction on the right. Urologist requested CT due to recurrent hydronephrosis.

Patient Data

Age: 35 years
Gender: Female

Due to problems with the injection site, the bolus injection rate was reduced to 3 ml / s - the density of the vessels were somewhat reduced to 210-230 HU. For 5-7 minutes before the study, 30 ml of Omnipaque 350 was injected.

  •  the renal pelvis on the right is expanded to 36 mm.
  •  there is an accessory lower pole renal artery from the right side of aorta.
  •  the lumen of the pelvic-ureteral segment in the proximal section does not exceed 1-2 mm  for up to 1 cm.
  •  the accessory lower pole artery passes nearby at a distance of more than 1.5 mm, probably there is close diligence.
  • with appropriate adjustment of the window, a decrease in the density of the right ureter is seen in comparison with the left side, which indicates a decrease in permeability while the density of the pelvis is symmetrical.

Other findings:

  • polycystic ovarian transformation is observed
  •  there is an accessory lower pole renal artery from the right side of aorta.
  •  the accessory lower pole artery passes nearby at a distance of more than 1.5 mm, probably there is close diligence.

Case Discussion

This case demonstrates the presence of an additional inferior renal artery as a cause of hydronephrosis. Taking into account the anamnesis, it is also impossible to exclude an element of postoperative cicatricial changes of the pyeloureteral junction. Due to the high blood pressure in comparison with the veins, an arterial vessel of even such a small diameter with its appropriate topographic location can create conditions for compression of the ureter with violation of the urodynamics.

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Case information

rID: 65179
Published: 31st Dec 2018
Last edited: 31st Dec 2018
System: Urogenital
Inclusion in quiz mode: Included
Institution: 3 ЦВКГ им. А.А.Вишневского

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