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

Febrile UTI in a 21-month-old baby girl. Ultrasonography showed a normal left kidney and right hydroureteronephrosis(Figure 1 and Figure 2). VCUG (Figure 3) showed a left reflux, grade 2, with good drainge. On the right, there was reflux into a hydronephrotic kidnew with a very dilated, tortuous ureter. the contrast material was diluted as it filled the dilated right pelvicalyceal system and ureter. A late drainage film showed prompt drainage of the left reflux, but on the right, there was obstruction at the end of the ureter (Figure 4). This is an example of the coexistence of right primary megaureter plus reflux. She underwent reimplantation of the left ureter and excision of the aperistaltic segment at the end of the right ureter, and then tapering and reimplantation of the right ureter.