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

This one-year-old girl presented with febrile urinary tract infection. VCUG showed symmetrical lower pole reflux (fig1). The only clue that there was right upper pole hydroureteronephrosis is that the right ureter had a serpiginous course as it wrapped around its dilated upper pole mate. Notice the difference in the course of the right (fig2) and left (fig3) lower pole ureters. This was confirmed on ultrasonography that showed the left kidney had a normal double collecting system without upper pole hydronephrosis (fig4), and that the right kidney was a duplex kidney with upper pole hydronephrosis (fig5). A DMSA scan showed that the left kidney had 59% uptake and the right 41%; of the 41%, 6% was taken up by the upper pole and 94% by the lower pole. She underwent bilateral common-sheath reimplant and plication of the upper pole ureter. The right upper pole ureter was an obstructed ectopic ureter (without a ureterocele). The post-op IVP showed a normal left duplex kidney and right lower pole. The right upper pole was decompressed (arrow fig6).

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