070116 LEFT URETEROPELVIC JUNCTION OBSTRUCTION

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070116 LEFT URETEROPELVIC JUNCTION OBSTRUCTION

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Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.

Patient: 9 year old male

History: Incidental finding during screening echocardiography for congenital vascular ring

Images:

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Fig. 1: Ultrasound, right flank


Fig. 2: Ultrasound, middle abdomen


Fig. 3: Ultrasound, left flank


Fig. 4: Ultrasound, lower abdomen


Fig. 5: T1 spoiled gradient echo, Coronal


Fig. 6: T2 half-Fourier acquisition single-shot turbo spin echo, Axial_1


Fig. 7: T2 half-Fourier acquisition single-shot turbo spin echo, Axial_2


Fig. 8: T2 half-Fourier acquisition single-shot turbo spin echo, Axial_3


Fig. 9: T2 half-Fourier acquisition single-shot turbo spin echo, Axial_4


Fig. 10: T2/T1 steady-state gradient echo, Axail


Fig. 11: Thick heavily T2 fast spin echo, Projective MR urography


Fig. 12: Thick multi-angles heavily T2 fast spin echo, Projective MR urography


Fig. 13: Heavily T2 half-Fourier acquisition single-shot turbo spin echo with fat suppressed thin images, Coronal


Fig. 14: Heavily T2 half-Fourier acquisition single-shot turbo spin echo with fat suppressed thin image, Maximum-intensity projection reconstruction


Fig. 15: Heavily T2 half-Fourier acquisition single-shot turbo spin echo with fat suppressed thin images, 3D animator


Fig. 16: NM, Dynamic study_1


Fig. 17: NM, Dynamic study_2

Images:

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Findings:

Figure 1-4(Ultrasound):
1. Normal right kidney.
2. Left severe hydronephrosis with paper-thin of cortex,
�� suggesting chronic high-grade obstructive uropathy.
3. Normal right ureter jet by color-Doppler image.
�� Non-visualization of left ureter jet.

Figure 5-15 (MR Urography without IV contrast):
1. Marked dilatation of left calyces and renal pelvis with rapid
�� tapering at ureteropelvic junction, in favor of ureteropelvic
�� junction obstruction (possibly congenital).
2. Paper-thin of left renal cortex, suggesting chronic high-grade
�� obstructive uropathy.
3. No abnormal finding in right kidney, right ureter, and bladder.

Figure 16,17(NM):
1. Decreased uptake of left kidney
�� MaxCounts(Kcpm) Left/Right=18.09/51.12=0.35

Diagnosis: Left ureteropelvic junction obstruction with chronic high-grade obstructive uropathy

Comments:

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Q: Why the MR urography was performed without IV contrast?

A: We use IV- contrast media (gadolinium) to evaluate most conditions of

abdominal disease. Howerver, we can perform MR urography by only

"heavily T2" images without IV- gadolinium. Furthermore, the gadolinium

may be secrete poorly into the left renal pelvis, because the poor left renal

function of our case. Generally, diuretic gadolinium-enhanced MR urography

is suited to non- or mild obstructive uropathy. (IV 0.1 mg/ kg of furosemide,

adult; 0.05 mg/ kg, children)

By Dr. Tsao

--pedrad CSH, 2007-01-20 06:25:15

Good MR images and good comments.

--jp s, 2010-02-24 04:24:05

i think no rule for gadolinium injection because the case is clear without injection . and if we want to decide about the kidney function I think the scintigram is the best.

--yaser murad, 2010-08-15 10:16:45

Additional Details:

Case Number: 7852062Last Updated: 02-19-2007
Rating:

4 ratings
Anatomy: Genitourinary (GU) Pathology: Congenital
Modality: MR, Nuc Med, US, 3D Reconstruction

Access Level: Readable by all users
Keywords: ureteropelvic junction obstruction, hydronephrosis

ACR: 813.1452Contained in: