Below the bladder neck, the prostatic urethra appears almost as an elongated teardrop with a posterior impression representing the verumontanum. Robotic reconstruction of the retrocaval ureter is gaining momentum as the method of choice for surgically treating this rare condition. Christopher rehbeck kelly and jaime landman to capture current clinical perspectives in nephrology and urology from normal anatomy, histology, physiology, and development to glomerular and tubular diseases, infections. Campbell 5 stated in his 1963 textbook that about 90 cases had been reported to date, and the diagnosis was made preoperatively in 28. Since the original report of retrocaval ureter in 1893, 44 cases have been reported in the literature. The ureter classically course medially behind the inferior vena cava winding around it and then passes laterally in front of it to then course distally to the bladder. A preureteric vena cava, also known as a retrocaval ureter, is a rare congenital malformation of the right human ureter, in which the ureter passes behind the inferior vena cava, causing compression possibly leading to hydronephrosis. Only one case in childhood has been previously reported,1 and this. Grade i reflux into nondilated ureter grade ii reflux into the renal pelvis and calyces without dilatation grade iii mildmoderate dilatation of the ureter, renal pelvis and calyces with minimal blunting of the fornices grade iv dilation of the renal pelvis and calyces with moderate ureteral tortuosity.
Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life from a resulting hydronephrosis. Retrocaval ureter rcu is a rare congenital anomaly in which the ureter passes posterior to the inferior vena cava ivc. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava ivc. Presenting a dams medicine unplugged, integrated learning video discussing the anatomical basis of retrocaval ureter.
Congenital anomalies of the ivcembryological perspectives. Retrocaval ureter anatomical basis saturday, august 03, 2019 genitourinary radiology. This technique usually is applied in rare or difficult cases, such as for assessment of a retrocaval ureter, ureteral tumors, and paraureteral pathology compressing or displacing the ureter. Lymphadenopathyiliac artery aneurysmbladder diverticulumpostsurgical esp. Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Also known as circumcaval ureter ureter courses posterior to the inferior. Retrocaval ureter is a rare entity1 with a reported incidence of approximately 1 in 1100 and a 2. Radiology spotters part 7 sturge weber syndrome duration. Full text full text is available as a scanned copy of the original print version. Her right ureter encircled the dorsal aspect of the inferior. Radiology spotter part retrocaval ureter damsdelhi pg medical entrance coaching. Due to the persistence of the right subcardinal vein in the lumbar area, the vena cava develops ventral of the right ureter zhang et al, 1990.
A second case is reported of its unusual association with retrocaval ureter. The limiting factors are the learning curve of laparoscopic operations and the difficulty in. Retrocaval ureter was diagnosed in a woman complaining of ureteric pain in the last trimester of pregnancy. We present a case of a 49yearold male who presented with loin pain and upon.
Ivp and ct demonstrate partial obstruction of the right renal collecting system with a retrocaval ureter. Twentytwo of these cases were diagnosed post mortem, and eight cases were diagnosed preoperatively. Ct scan below the level of the kidneys demonstrates a more medial retrocaval placement of the right ureter. The bladder narrows like a funnel into the bladder neck. It is a term used to describe an abnormal course of a ureter that encircles the ivc. We describe the rationale behind the administration of epidural analgesia for her colic attack. Super coding tips for 36147 av fistula or shunt or graft among 3 types of hemodialysis, dialysis fistula is the best choice. A 41yearold pregnant woman was hospitalized with a diagnosis of a marginal placenta previa at 34 weeks and 5 days of pregnancy. Retrocaval ureteranatomical basis sumers radiology blog. The ureter is slightly dilated proximal to this point and returns to a normal position distal to its retrocaval placement.
Retrocaval ureter in turner syndrome sciencedirect. Retrocaval ureter, venacaval duplication, angiogenesis jcdr. A 14 year old male presented with a three months history of right flank pain that was of sudden onset and initially colicky but had become constant. The etiology is related to abnormal development of the inferior vena cava ivc, and not the ureter itself, resulting in a portion of the ureter passing behind the ivc. Urinalysis was negative for red blood cells, white blood cells, or protein. The images showed that the upper part of the right ureter was dilated and the portion. For the treatment of this condition, classical open pyeloplasty techniques had. Home genitourinary radiology retrocaval ureter anatomical basis. Cardiac radiology genitourinary radiology learning radiology. From the departments of radiology and surgery division of urology, duke university medical center, durham, north carolina abstract turner syndrome is commonly associated with urinary tract anomalies.
End stage renal failure peritoneal dialysis, dialysis. A retrocaval ureter, which is also called circumcaval ureter, is an abnorm development of vena cava and ureter. Sesboue collected 56 cases published between 1893 and 1952 and bitker found 84 more between 1952 and 1964. We found in the literature only anecdotal cases of nonobstructive retrocaval ureter followed expectantly.
Full blood count, urinalysis and blood urea and creatinine were normal. A retrocaval ureter is an uncommon congenital anomaly with an incidence of 1. Although venous in origin, this malformation of the ureteral path may damage the excretory tract and kidney above. There are some tips you should know to car your av fistula. A 60yearold man presented with a 30year history of back pain which had worsened over 3 days. Learningradiology retrocaval ureter, circumcaval ureter. This process is experimental and the keywords may be updated as the learning algorithm improves. Congenital anomalies radiology linkedin slideshare. Learningradiology causes of ureteral deviation, displacement. Get a printable copy pdf file of the complete article 1. On imaging, retrocaval ureter appears like a fish hook or a reverse j, with the proximal ureter appearing at the level of the lumbar pedicles. A retrocaval ureter is a congenital anomaly in which the ureter passes behind and is compressed by the inferior.
Novel imaging techniques might facilitate the diagnoses of the reported cases. Diagnosis and laparoscopic management of retrocaval ureter. The netter collection of medical illustrations urinary. Type 1 is the more common form, and has the characteristic s or fishhook deformity of the ureter. Ct scan demonstrates rightsided hydronephrosis and hydroureter because the right ureter passes behind the inferior vena cava at the level of lower endplate of l3 vertebra. Circumcaval ureter, also known as retrocaval ureter, is a term used to describe an abnormal course of a ureter that encircles the inferior vena cava. As the right ureter hooks behind the ivc, it has also been referred to as an sshaped ureter. Pain on percussion of the right lumbar region was evident on physical examination. Fishhook ureters, also known as jshaped ureters or hockey stick ureters describe the appearance of the distal ureter in patients with significant benign prostatic hypertrophy. Links to pubmed are also available for selected references. It is sometimes bilateral and is often located in the upper twothirds of the ureter. Interventional radiology medical coding learn how to code.
Duplication of ivc is another rare congenital anomaly in the development of ivc. Circumcaval ureterretrocaval ureter bmj case reports. The lumen of the prostatic urethra is lined with the same type of urothelium that lines the bladder, ureter. Retrocaval ureter or circumcaval ureter, is a rare congenital anomaly that arises from dysgenesis of the inferior vena cava ivc and should be more appropriately called preureteral vena cava. There are two types of retrocaval ureter according to the classification scheme proposed by bateson and atkinson.
Retrocaval ureter also referred to as circumcaval ureter or preureteral vena cava is a rare congenital anomaly with the ureters passing posterior to the inferior vena cava. After informed consent of the patient was taken, a right ureteroureterostomy was performed after mobilising ureter anterior to ivc. Ureteral pseudodiverticulosis are acquired false diverticula resulting from herniation of epithelium through the muscularis layer of the ureter and characterized by the presence of multiple outpouchings smaller than 5 mm. Retrocaval ureter medigoo health medical tests and. We think that the radiologic findings and intraoperative appearance of the ureter should be used to. Learn the truth about uterine fibroids once and for all and finally get the.
The findings on iv urography are correlated with the mri findings. Magnetic resonance urography mru is a powerful new tool for imaging the ureter and urinary tract. The retrocaval ureter is a rare congenital entity that causes external compression of the proximal ureter and usually becomes symptomatic in the third or fourth decade of life 1. Imaging studies are usually sufficient for an accurate preoperative diagnosis, which is important for successful surgical intervention 2. It has also been used to describe the appearance of a retrocaval ureter in type 1 or low loop variety. Spiral computed tomography scan and magnetic resonance imaging have been recently considered the tool of choice for the diagnosis of inferior vena caval abnormalities. Retrocaval ureter, circumcaval ureter learningradiology. Ossification of the posterior longitudinal ligament opll. Retrocaval ureter also referred to as preureteral vena cava is a rare congenital anomaly with the ureter passing posterior to the inferior vena cava.
Congenital abnormalities of the ureter sciencedirect. Type 1 has a fish hook or s shaped appearance and is the more prevalent variety and type 2 which is. A retrocaval ureter is a congenital anomaly in which the ureter passes behind and is compressed by the inferior vena cava. The prevalence of this condition is approximately 1 per 1,000 persons, with males 23 times more likely than females to develop the condition. A little over 200 cases have been reported worldwide since hochstetters first report in 1893. Retrocaval ureter preureteric vena cava retrocaval ureter or, more precisely, preure teric vena cava is a rare abnormality but one that has a very characteristic radiographie appearance. The book provides comprehensive coverage of the latest imaging techniques with an emphasis on newer modalities such as ct intravenous pyelograms ctivp and. A casebased reference for diagnosing urologic disorders teaching atlas of urologic imaging presents a casebased approach to selecting the multimodality imaging strategies for the most frequently encountered urologic disorders. Alzheimers disease, mri scan i will be doing a study on this in my sketchbook to support my research on dementia this has helped me understand a little more about the desease and will make a good piece of art in my book.
However, we believe mri is likely to replace ct in the diagnosis of retrocaval. The circumcaval ureter is a rare congenital anomaly usually associated with upper urinary tract hydronephrosis. Renal calculi are also present, presumably due to stasis. An awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. The patient was treated with intravenous antibiotics and drainage of the right kidney by a double j stent with retrograde ureteropyelography that confirmed the diagnosis of retrocaval ureter, antibiotic treatment continued for 2 weeks orally, and laparoscopic repair of retrocaval ureter was planned after sterilization of the urine. Minimally invasive approach of a retrocaval ureter. Robotic ureteroureterostomy of the retrocaval ureter. This volume in the netter collection of medical illustrations the ciba green books has been expanded and revised by drs. Case of the week 488 on awardwinning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, gi, cardiac and musculoskeletal diseases containing over 300 powerpoint lectures, quizzes, handout notes, interactive material, most commons lists and pictorial differential diagnoses. So far ct has been the procedure of choice to confirm the diagnosis of retrocaval ureter. Presenting a dams medicine unplugged, integrated learning video discussing. Laparoscopic ureteroureterostomy for retrocaval ureter. A majority of the cases are clinically silent and they are diagnosed incidentally during imaging studies which are done for other reasons 2.