Indian Journal of Nuclear Medicine

INTERESTING IMAGE
Year
: 2016  |  Volume : 31  |  Issue : 1  |  Page : 74--76

A rare pediatric case of grossly dilated ureter presenting as abdominal mass


Madhur Kumar Srivastava1, Krishna Kumar Govindarajan2, Sunitha Vellathussery Chakkalakkoombil3, Dhanapathi Halanaik1,  
1 Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3 Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Correspondence Address:
Madhur Kumar Srivastava
Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry - 605 006
India

Abstract

Renal masses account for 55% of cases presenting as palpable abdominal mass in children. [1] An eight year male presented with palpable abdominal mass and pain.The patient underwent renal dynamic scan,which raised possibility of left duplex kidney with non-functioning moiety,as the size of left kidney was smaller than seen on Ultrasonography (USG). Magnetic resonance (MR)urography confirmed the findings with patient undergoing left hemi-nephrectomy and is doing well.In case of discrepancy in size of kidney on USG and renal scan,duplex kidney should be considered as differential,other causes being, renal cyst,benign/malignant mass and renal calculi.Gross hydro-ureter presenting as palpable abdominal mass is very rare with few reported cases. [2],[3],[4]



How to cite this article:
Srivastava MK, Govindarajan KK, Chakkalakkoombil SV, Halanaik D. A rare pediatric case of grossly dilated ureter presenting as abdominal mass.Indian J Nucl Med 2016;31:74-76


How to cite this URL:
Srivastava MK, Govindarajan KK, Chakkalakkoombil SV, Halanaik D. A rare pediatric case of grossly dilated ureter presenting as abdominal mass. Indian J Nucl Med [serial online] 2016 [cited 2019 Nov 19 ];31:74-76
Available from: http://www.ijnm.in/text.asp?2016/31/1/74/172371


Full Text

An 8-year-old male child presented with pain abdomen, not localizing to any side since 1 week and palpable abdominal mass noticed since 2 days. The patient was sent for routine blood investigations, ultrasonography (USG), and renal dynamic scan. USG showed bilateral enlarged kidneys with hydroureteronephrosis and thin parenchyma. The left ureter (LU) was grossly dilated. The patient underwent technetium-99m ethylene cysteine (Tc-99m EC) scan. The right kidney (RK) was enlarged with reduced perfusion and radiotracer uptake showing obstructive drainage pattern and dilated tortuous ureter [Figure 1]. The left kidney (LK) appeared smaller in size compared to RK on renal scan contrary to USG findings; hence, the possibility of duplex system in LK was raised with good functioning nonobstructed upper moiety and nonfunctioning lower moiety showing no radiotracer uptake until the end of the study. As the doubt about left duplex system was raised on Tc-99m EC scan, with no such mention in USG report, the patient was scheduled for MR urography.

Patient underwent magnetic resonance (MR) urography on subsequent day and images showed duplicated collecting system of the left kidney. The upper moiety showed normal pelvi-calyceal system and ureter of the upper moiety while the lower moiety showed gross hydronephrosis with thinned out renal parenchyma and markedly dilated and tortuous ureter until the lower end [Figure 2]. The RK was hydronephrotic with reduced parenchymal thickness and showing dilated, tortuous, kinked right ureter until the lower end where it was being externally compressed by dilated left ureter. The patient underwent left lower pole hemi-nephrectomy [1] for the nonfunctioning lower moiety. Postoperatively, the patient is doing well [Figure 3].{Figure 1}{Figure 2}{Figure 3}

Renal masses account for 55% of cases presenting as a palpable abdominal mass in children. [2] In our case, as USG did not mention about duplex system in its report, but Tc-99m EC scan suggested left duplex system due to discrepancy in left kidney size when compared to USG, the patient was scheduled for MR urography. MR urography confirmed left side duplex system and showed grossly dilated LU as the cause of palpable abdominal mass. It also showed that the hydronephrosis in RK with tortuous RU was likely due to the pressure of dilated LU on the lower third of RU. In case of discrepancy in the size of the kidney on USG and renal scan, duplex kidney should be considered as differential, other causes being, renal cyst, benign/malignant mass and renal calculi. However, most of these causes can be differentiated on USG. Gross hydro-ureter presenting as palpable abdominal mass is very rare with few reported cases. [3],[4],[5] The problem in the diagnosis of renal masses is common on USG. [6]

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Nil.

Conflicts of interest

There are no conflicts of interest.

References

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