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Year : 2003  |  Volume : 13  |  Issue : 2  |  Page : 189-190
Signs : Ureterocele - the "adder head" appearance


Department of Radiodiagnosis, G.R Medical College and J.A. Group of Hospitals, Gwalior, Madhya Pradesh, India

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Keywords: Ureterocele

How to cite this article:
Saxena P, Iyer S G, Sharma G L, Saxena U D. Signs : Ureterocele - the "adder head" appearance. Indian J Radiol Imaging 2003;13:189-90

How to cite this URL:
Saxena P, Iyer S G, Sharma G L, Saxena U D. Signs : Ureterocele - the "adder head" appearance. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Sep 21];13:189-90. Available from: http://www.ijri.org/text.asp?2003/13/2/189/28657
A forty-five year old lady presented with complaints of recurrent episodes of loin pain and fever for three years.

A ureterocele is a congenital saccular dilatation of the terminal portion of the ureter. Ureteroceles may be categorized based on their relationship with their renal unit or based on their distal ureteral configuration and location.

The following are the different types of ureteroceles classified by their association with the renal unit.

  1. Single system ureteroceles are those associated with a single kidney, a single collecting system, and a solitary ureter.
  2. Duplex system ureteroceles are associated with kidneys that have a completely duplicated collecting system and two ureters.
  3. Orthotopic ureterocele is a ureterocele whose orifice is located in a normal anatomic position within the bladder. These are commoner in adults.
  4. Ectopic ureterocele refers to those ureteroceles whose orifices are located in an ectopic position, such as the bladder neck or urethra. They typically arise from the upper pole moiety of a duplicated collecting system and are more common in the pediatric population.


Incidence: In approximately 1 in 4000 children. Females are affected 4-7 times more often than males. 10% occur bilaterally. In adults too, ureteroceles are more frequent in females, and 17-35% of ureteroceles occur in an orthotopic form.

Etiology: The most commonly accepted theory behind ureterocele formation is the obstruction of the ureteral orifice during embryogenesis, with incomplete dissolution of the Chwalla membrane (A thin primitive membrane that separates the ureteral bud from the developing urogenital sinus).


   Imaging Top


[A] Renal and bladder sonography is the first-line imaging study for evaluating the upper and lower urinary tract in the pediatric population.

  • Ureterocele is seen as a fluid-filled intravesical mass. It is also known as "cyst within a cyst."
  • Hydroureteronephrosis is noted as a dilatation of renal pelvis and the proximal ureter.
  • Renal ultrasonography also provides information on the thickness of renal cortex and echogenicity of renal parenchyma. (The degree of echogenicity is indirectly proportional to the degree of renal dysplasia that is present.)
  • Bladder ultasonography documents the efficiency of bladder emptying by noting the volume of post void residual urine.
  • On antenatal sonograms, the typical presentation is that of an enlarged hydronephrotic fetal kidney. Renal duplication and/or ureteral duplication may be seen. Intravesical cystic dilation or septa within the bladder (which represent ureterocele walls) suggest that the etiology of the hydronephrosis may be an ureterocele.


[B] Micturating cystourethrogram (MCU) is essential to evaluate the lower urinary tract for a ureterocele, urethral diverticulum, posterior urethral value (PUV) ectopic ureter, and vesicoureteral reflux.

  • Ureterocele appears as a smooth, round filling defect along the base of the bladder.
  • Urethral diverticulum appears as an out pouching of the urethra. A urethral diverticulum also may represent an everting ureterocele.
  • MCU can be used to document the efficiency of bladder emptying with assessment of the volume of post void residual urine.


[C] Intravenous pyelogram (IVP) is useful for delineating renal anatomy and providing a subjective estimation of relative renal function. The following may be seen on IVP:

  • Hydronephrotic upper pole displacing the lower ole moiety laterally and inferiorly (i.e., the "drooping lily" sign.)
  • Ureteral displacement by the hydroureter or hydronephrotic upper pole moiety.
  • "Cobra-head" or Adder-head" extension of the distal ureter (seen in adults) is classical and is diagnostic.


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Correspondence Address:
S G Iyer
M-601, Dharma Apartments, Patparganj, I.P.Extension, Delhi-110092
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2], [Figure - 3]

This article has been cited by
1 Incidental sonographic finding of bilateral ureteroceles
Ayers, E.
Journal of Diagnostic Medical Sonography. 2006; 22(2): 123-126
[Pubmed]



 

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