retrocaval ureter

1. CASE 2

2. History
• 57 year old female
• C/o right flank pain since 10 years
• Dull aching and intermittent in nature.
• No h/o fever with chills/hematuria/ lithuria /AUR/LUTS.

3. Past history
• K/c/o VSD on medical follow-up.
• No h/o HTN/DM/CAD/COPD /CVA/PTB.
• No h/o previous surgeries.

4. Examination
• Pulse rate: 76/min, BP: 130/80 mm of Hg.
• No pallor, no icterus and no cyanosis.
• Abdomen – soft, non tender. No mass palpable.
• EG: Meatus-normal, Vulva-normal

5. Investigations
Hb: 10.2 RBS: 123 INR- 1.10 HCV: Negative
TC: 10700 B. Urea:10 Na+: 135 HIV: Negative
PLT: 4.05 lakhs S. Cr: 0.5 K+: 3.9 HBsAg:
VDRL
Negative
Negative

6. USG KUB
• Right Kidney : Normal in site size shape and echo texture . CMD
maintained . Right HDUN noted . Lower ureter not visualized
• Left kidney- : Normal in site size shape and echo texture . CMD
maintained .
• U.B – Normal .

7. CT Urogram
• Right kidney –Moderate Right hydronephrosis with
asymmetrically dilated . (Pelvic APD- 3.4 cm).
• Right upper ureter is dilated with abrupt medial deviation ~ 4.2
cm distal to PUJ where it is seen behind the IVC and crossing
medial and anterior to it. Distal ureter normal.
• Left Kidney-Normal.
• UB-Distended

8. IVU
• Plain X Ray Abdomen-normal.
• Nephrogram phase-Bilateral kidneys
normal in size and shape.
• 5 min film-Right PCS-Dilated. Left
PCS-Normal.
• 15 min film-Right proximal ureter
appears dilated and deviated medially.
Right mid ureter-not visualized. Right
distal ureter normal. Left ureter –normal.
• 30 min-UB-Normal.