Department Of Ultrasonography, Balku's Scan, Pvs Hospital, Calicut -673 002, Kerala, India
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|Date of Submission||20-Mar-2006|
|Date of Acceptance||10-Aug-2006|
| Abstract|| |
The ultrasonographic detection of fetal hydronephrosis demands a thorough search for the presence of ureterocele. This case illustrates a classical unilateral ureterocele diagnosed at 30 weeks of gestation. The pregnancy was uneventful ending in normal vaginal delivery. The neonatal cystoscopic findings supported the definitive antenatal diagnosis.
Keywords: Fetal ureterocele, antenatal ultrasound diagnosis, fetal urinary tract anomalies
|How to cite this article:|
Balakumar K. Antenatal ultrasound diagnosis of ureterocele. Indian J Radiol Imaging 2006;16:823-4
| Introduction|| |
The fetal ureterocele is occasionally reported as a cause of unilateral or bilateral hydronephrosis. The diagnosis is more specific with high-resolution ultrasound machines as illustrated by the following case. It helps to plan the antenatal or postnatal investigational and interventional procedures at the apt time.
| Case report|| |
A primigravida was referred for routine ultrasound scanning at 30 weeks of gestation. Scanning (using Aloka Prosound 5000, 2.5-5 MHz probe) showed normal placental echoes and a fetus with normal biometry. The liquor volume was normal for this period of gestation. The left kidney was severely hydronephrotic (grade IV) along with a tortuous hydroureter. The urinary bladder volume was normal, and it showed periodical emptying. A thin walled smooth cystic projection of 26 mm diameter was seen with in the bladder ('cyst within the cyst' appearance), inseparable from the left vesical wall. Reassessment after few minutes showed the partially emptied bladder enclosing the smooth cystic mucosal projection. The posterior urethra showed no dilation. The right kidney and the ureter were normal. There was no evidence of a double collecting system on either side. These features were typical of an ureterocele causing unilateral ureterohydronephrosis. Further careful scrutiny revealed no other associated anomaly.
| Discussion|| |
The ureterocele results from submocosal cystic dilation of the distal ureter and is four times more common among the females ,. This may present as intravesical or extravesical dilation with or with out hydroureter or hydronephrosis. Often associated with duplex kidneys (ectopic ureterocele), the upper moiety of the involved kidney may show associated stasis along with hydroureter. This case was showing no definite evidence of duplex kidneys. The classical sign of a 'cyst with in a cyst' was demonstrable when the fetal bladder was full. This finding together with ipsilateral ureterohydronephrosis was diagnostic of ureterocele. The antenatal diagnosis of ureterocele by ultrasonography is more specific, if the classical sign of 'a cyst with in a cyst' is defined . If the fetal bladder is empty, the diagnosis is likely to be missed .
Ureterocele shows a predilection for the left side  with bilateral involvement in 10 - 15 % . The differential diagnoses may include ectopic ureter, prolapsed ureter, bladder diverticulum, mesonephric duct cyst and urethral polyp. This patient had normal volume of amniotic fluid, as the obstruction was unilateral. In those cases of large or bilateral involvement causing anhydramnios, percutaneous needle decompression (fetal vesicoamniotic shunt) may restore normal amniotic fluid volume . The other antenatal treatment options are endoscopic laser ablation or colander perforation of the ureterocele .
The classical 'cobra head sign' ('adder head sign') on urography is diagnostic of ureterocele after birth. A detailed postnatal work up including scintigraphy is necessary for proper evaluation to avoid future renal complications .
| References|| |
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Balku's Scan, Railway Station Road, Pvs Hospital, Calicut 673 002, Kerala
Source of Support: None, Conflict of Interest: None
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