Robert Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

PMH: One-month old female with prenatal diagnosis of right hydronephrosis.

Radiology: Postnatal renal ultrasound, VCUG, and IVP

Duplicated System with Secondary Obstruction

Postnatal ultrasound examination showed a ureterocele in the bladder with a proportionally dilated upper pole ureter(Fig. 1 and 2). both the upper and lower pole collecting systems of the kidney were dilated. The most likely diagnosis was upper pole hydroureteronephrosis from distal obstruction with ectopic ureterocele and lower pole reflux. The VCUG showed the ureterocele, but no reflux(Fig. 3). Thus, the most likely diagnosis became secondary obstruction of the proximal portion of the lower pole ureter by the crossing upper pole ureter. This was confirmed on the IVP(Fig. 4).

Right Kidney

Bladder

Voiding Cystourethrography

Intravenous Pyelogram