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

UPJ Obstruction from a Crossing Renal Vessel

A 10 year-old girl had several years of intermittent, unexplained left abdominal pain and vomiting. The symptoms came on suddenly, lasted hours or occasionally days, and then resolved spontaneously. Ultrasonography showed a very dilated left pelvicalyceal system (Figure 1) and IVP showed severe obstruction (Figure 2). A retrograde ureterogram showed extrinsic obstruction from a crossing lower pole renal artery (Figure 3). The obstruction due to the artery was confirmed at operation and a dismembered pyeloplasty was performed. She has had no symptoms since surgery. An IVP postoperatively showed a normal, completely decompressed left pelvicalyceal system (Figure 4). Note the redundant urothelium in the renal pelvis.