Answer for CoW 26 Nov 2017
Left PUJ obstruction
Findings
Left pelvi-ureteric junction obstruction causing gross dilatation of collecting system of left kidney causing renal parenchymal thinning. On contrast, enhancement of renal parenchyma is noted and left ureter is not visualised.
Discussion
Pelvi-ureteric junction (PUJ) obstruction/stenosis, also known as ureteropelvic junction (UPJ) obstruction/stenosis, can be one of the causes of an obstructive uropathy. It can be congenital or acquired with a congenital PUJ obstruction being one of the commonest causes of antenatal hydronephrosis. PUJ obstruction is most commonly unilateral but is reported to be bilateral in ~30% (range 10-49%) of cases. There is a recognised predilection towards the left side (~67% of cases). During embryogenesis, the pelvi-ureteric junction forms usually around the fifth week and the initial tubular lumen of the ureteric bud become recanalised by ~10-12 weeks. The PUJ area is the last to recanalize. Inadequate canalization is thought to be the main embryological explanation of a PUJ obstruction. Extrinsic obstructions secondary to bands, kinks, and aberrant vessels also are commonly encountered.
Findings
Left pelvi-ureteric junction obstruction causing gross dilatation of collecting system of left kidney causing renal parenchymal thinning. On contrast, enhancement of renal parenchyma is noted and left ureter is not visualised.
Discussion
Pelvi-ureteric junction (PUJ) obstruction/stenosis, also known as ureteropelvic junction (UPJ) obstruction/stenosis, can be one of the causes of an obstructive uropathy. It can be congenital or acquired with a congenital PUJ obstruction being one of the commonest causes of antenatal hydronephrosis. PUJ obstruction is most commonly unilateral but is reported to be bilateral in ~30% (range 10-49%) of cases. There is a recognised predilection towards the left side (~67% of cases). During embryogenesis, the pelvi-ureteric junction forms usually around the fifth week and the initial tubular lumen of the ureteric bud become recanalised by ~10-12 weeks. The PUJ area is the last to recanalize. Inadequate canalization is thought to be the main embryological explanation of a PUJ obstruction. Extrinsic obstructions secondary to bands, kinks, and aberrant vessels also are commonly encountered.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!