Answer for BIR CoW 06 Aug 2023
Transcaval ureter with hydroureteronephrosis
Findings
Right proximal ureter and pelvic calyceal system appears dilated on plain images. On intravenous contrast administration shows partially duplicated IVC at the level of L3 vertebra causing compression of right proximal ureter results in HUN. On delayed phases , excretion of contrast noted with compression of right proximal ureter between the segmental duplicated IVC.
Discussion
A transcaval ureter results from anomalous development of the IVC and not from anomalous development of the ureter. Transcaval ureter is a rare condition caused by abnormality in the embryogenesis of the IVC.It results from a segmental duplication of the IVC which creates a venous ring that encircles the right ureter. Transcaval ureter is more commonly to arise when the right posterior cardinal and right supracardinal veins fail to regress adjacent to the level of the kidney.The resulting partial duplication in the infra renal IVC creates a venous ring through which the right ureter can pass. The deviated portion of the ureter splits the IVC and therefore courses less medially than in retrocaval ureters. Differential include: Retrocaval Ureter On IVU, retrocaval ureter is characterized by hydronephrosis and extreme medial deviation (“fish hook deformity”) of the middle ureteral segment where it passes behind the IVC, usually at the L3 vertebral level.
Reference: Giddy S, Thangasamy I, Vega Vega A. Transcaval ureter: a rare embryological anomaly causing obstructive uropathy. BMJ Case Rep. 2015 Feb 18;2015:bcr2014208076. doi: 10.1136/bcr-2014-208076. PMID: 25694637; PMCID: PMC4336895.
Findings
Right proximal ureter and pelvic calyceal system appears dilated on plain images. On intravenous contrast administration shows partially duplicated IVC at the level of L3 vertebra causing compression of right proximal ureter results in HUN. On delayed phases , excretion of contrast noted with compression of right proximal ureter between the segmental duplicated IVC.
Discussion
A transcaval ureter results from anomalous development of the IVC and not from anomalous development of the ureter. Transcaval ureter is a rare condition caused by abnormality in the embryogenesis of the IVC.It results from a segmental duplication of the IVC which creates a venous ring that encircles the right ureter. Transcaval ureter is more commonly to arise when the right posterior cardinal and right supracardinal veins fail to regress adjacent to the level of the kidney.The resulting partial duplication in the infra renal IVC creates a venous ring through which the right ureter can pass. The deviated portion of the ureter splits the IVC and therefore courses less medially than in retrocaval ureters. Differential include: Retrocaval Ureter On IVU, retrocaval ureter is characterized by hydronephrosis and extreme medial deviation (“fish hook deformity”) of the middle ureteral segment where it passes behind the IVC, usually at the L3 vertebral level.
Reference: Giddy S, Thangasamy I, Vega Vega A. Transcaval ureter: a rare embryological anomaly causing obstructive uropathy. BMJ Case Rep. 2015 Feb 18;2015:bcr2014208076. doi: 10.1136/bcr-2014-208076. PMID: 25694637; PMCID: PMC4336895.
Note:
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!
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!