| Discussion: A congenital anatomical variant in the course of the right ureter.
Normally the right ureter remains lateral to the inferior vena cava (IVC).
In retrocaval ureter it passes medially and posteriorly to the IVC at the level of the midlumbar spine, to the IVC. It is also known as circumcaval or postcaval ureter.
Embryologically, the condition is due to development of the infrarenal IVC than from the right posterior cardinal vein rather than the right supracardinal vein.
The condition is usually an incidental finding, but occasionally symptoms may develop secondary to obstruction, stone formation or sepsis.
At urography, there is a typical hook-like deviation of the right midureter, from lateral to medial, with variable proximal hydroureteronephrosis The ureter gradually returns to its normal position inferiorly. This "S-shaped" or "reverse J" deformity is characteristic.
The diagnosis can be confirmed by CT or MRI which also exclude retroperitoneal fibrosis or mass as a cause of ureteric deviation. Retrocaval ureter can occasionally occur on the left side, if there is a left-sided or duplicated IVC.
http://www.amershamhealth.com/medcyclopaedia/volume%20iv%202/ureter%20retrocaval.asp
|
27 YO FEMALE WITH HYDRONEPHROSIS
