Retrocaval Ureter (Pre-Ureteral Vena Cava) – Rare Cause Of Hydroureteronephrosis, An Interesting Case Report

RETROCAVAL URETER (or PRE-URETERAL VENA CAVA) is a rare congenital abnormality arising from dysgenesis of the inferior vena cava (IVC) that results in the right ureter coursing posterior and medial to the inferior vena cava (IVC), causing varying degrees of obstructive proximal hydroureteronephrosis, a rare cause of long-standing cyclical flank pain. Retrocaval ureter (or Pre-ureteral vena cava) is asymptomatic until the 3rd and 4th decades of life from resulting hydronephrosis. Ultrasonography (USG), Intravenous urography (IVU), nuclear scintigraphy, Computed tomography urography (CTU), and Magnetic resonance urography (MRU) have been used in the diagnosis of this abnormality. Computed tomography urography (CTU) depicts the findings in three dimensions gives the most “wholesome” solution to its diagnosis. This condition is differentiated from other urinary tract obstruction causes, especially urolithiasis, essential for successful surgical management. When symptomatic, the situation is treated surgically, either by laparoscopic or open surgery. We report a case of a 50 years old male both with right flank pain and associated hydronephrosis.

Preoperative estimate of natural ureteral length based on computed tomography and/or plain radiography

To predict natural ureter lengths based on clinical images. We reviewed our image database of patients who underwent multiphasic computed tomography urography from January 2019 to April 2020. Natural ureteral length (ULCTU) was measured using a three-dimensional curved multiplanar reformation technique. Patient parameters including age, height, and height of the lumbar spine, the index of ureteral length using kidney/ureter/bladder (KUB) radiographs (C-P and C-PS) and computed tomography (ULCT) were collected. ULCTU correlated most strongly with ULCT. R square and adjusted R square values from multivariate regression were 0.686 and 0.678 (left side) and 0.516 and 0.503 (right side), respectively. ULCTU could be estimated by the regression model in three different scenarios as follows: ULCT + C-P ULCTUL = 0.405 $$\times$$ × ULCTL$$+$$ + 0.626 $$\times$$ × C-PL – 0.508 cm ULCTUR = 0.558 $$\times$$ × ULCTR$$+$$ + 0.218 $$\times$$ × C-PR + 6.533 cm ULCT ULCTUL = 0.876 $$\times$$ × ULCTL$$+$$ + 6.337 cm ULCTUR = 0.710 $$\times$$ × ULCTR$$+$$ + 9.625 cm C-P ULCTUL = 0.678 $$\times$$ × C-PL$$+$$ + 4.836 cm ULCTUR = 0.495 $$\times$$ × C-PR$$+$$ + 10.353 cm We provide equations to predict ULCTU based on CT, KUB or CT plus KUB for different clinical scenarios. The formula based on CT plus KUB provided the most accurate estimation, while the others had lower validation values but could still meet clinical needs.

Castleman Disease of the Kidney in Computed Tomography Urography

Background: Castleman disease (CD) of the kidney is extremely rare. In this study, we presented a case of CD of the left kidney and comprehensively described the findings of computed tomography urography. Case Presentation: The case involved unusual imaging characteristics of the focal central cystic area. Conclusion: The small and regular cyst-like structures and the hyperdense mass relative to the renal parenchyma in plain scans might help distinguish the CD of the kidney from other hypervascular tumors.

Adrenal cavernous hemangioma misdiagnosed as pheochromocytoma: a case report

Background Adrenal hemangioma is a rare benign adrenal tumor that is usually misdiagnosed preoperatively. We here present a case of adrenal cavernous hemangioma that was successfully treated with retroperitoneal laparoscopic adrenalectomy. Case presentation A 67-year-old man with dull right back pain attended our clinic for examination of a mass on the right adrenal gland for 1 week. Pheochromocytoma was considered according to the preoperative computed tomography angiography + computed tomography urography findings and was subsequently corrected to adrenal gland hemangioma according to postoperative pathological findings. The patient showed no recurrence of adrenal hemangioma during the 1-year follow-up period after surgery. Conclusion Adrenal gland hemangioma is rare with a high rate of misdiagnosis, and it should be considered in imaging findings of adrenal tumors with typical hemangioma. Surgery is an effective treatment method.

Iatrogenic bladder injury from port insertion during laparoscopic appendicectomy

A 26-year-old man underwent laparoscopic appendicectomy for acute appendicitis that was carried out uneventfully after initial urethral catheterisation to empty the bladder. Postoperatively, he developed oliguria associated with high drain output and elevated drain fluid creatinine. A contrast-enhanced computed tomography urography scan showed a small amount of contrast in the intraperitoneal space. A diagnostic laparoscopy performed for a suspected bladder injury revealed that the drain (inserted via the suprapubic port) had traversed the bladder. The drain was removed, and the bladder defects were repaired. The catheter was removed 2 weeks later uneventfully. It is important to recognise and avoid the urinary bladder during suprapubic port insertion during laparoscopic appendicectomy. This complication can be minimised via initial bladder decompression and introduction of the suprapubic port lateral to the umbilical ligaments. A high index of suspicion is required to diagnose a small bladder injury.

CTU findings of duplex kidney in kidney: A rare duplicated renal malformation

Duplex kidney is a common congenital malformation appeared as duplication of pelvis and ureter. However, renal duplication within sinus renalis is an extremely rare variation of the renal collecting system. In this study, we report a case of an asymptomatic kidney disease in a 33-year-old man, who demonstrates abnormal echo of renal sinus anomaly discovered incidentally in ultrasound examination. Computed tomography urography (CTU) exhibited the other small duplex kidney located in renal sinus. In the excretory phase images, the contrast medium within its small renal pelvis could be seen to flow into the right major renal calices. This case exhibited a very rare anatomical variation of duplicated renal malformation.