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UROLOGICAL IMAGES
Year : 2018  |  Volume : 34  |  Issue : 1  |  Page : 85-86
 

Ureteropelvic junction obstruction - mimicking an “elephant head” on magnetic resonance imaging


Department of Urology, Lourdes Hospital, Kochi, Kerala, India

Date of Submission15-Sep-2017
Date of Acceptance07-Oct-2017
Date of Web Publication29-Dec-2017

Correspondence Address:
Hariharan Krishnamoorthy
Department of Urology, Lourdes Hospital, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_282_17

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   Abstract 

Ureteropelvic junction obstruction (UPJO) with giant hydronephrosis is relatively rare in adults as compared to children. Most of the UPJO reported or seen in daily practice have a distinct hydronephrosis with a narrow ureteropelvic junction and a collapsed ureter distally. We present images a case of an adult female with Left UPJO, which on MRI mimicked an 'elephant head'.



How to cite this article:
Mehta SB, Krishnamoorthy H, Pillai B. Ureteropelvic junction obstruction - mimicking an “elephant head” on magnetic resonance imaging. Indian J Urol 2018;34:85-6

How to cite this URL:
Mehta SB, Krishnamoorthy H, Pillai B. Ureteropelvic junction obstruction - mimicking an “elephant head” on magnetic resonance imaging. Indian J Urol [serial online] 2018 [cited 2019 Sep 20];34:85-6. Available from: http://www.indianjurol.com/text.asp?2018/34/1/85/221970



   Introduction Top


Ureteropelvic junction obstruction (UPJO) is diagnosed by various modalities ranging from ultrasound of abdomen to diethylenetriaminepentaacetic acid (DTPA) scan. However, some cases might present with a distinct image on a radiological investigation and may pose a diagnostic dilemma. We report such a case with an aim to present a varied magnetic resonance imaging (MRI) presentation of UPJO.


   Case Report Top


A 19-year-old female presented with dull aching left flank pain for the past 6 months. The ultrasonography of abdomen suggested of left gross hydroureteronephrosis. MRI showed a grossly dilated left renal pelvis and a dilated tortuous ureter, suggestive of the primary obstructive megaureter, mimicking an “elephant head” appearance [Figure 1]. The DTPA scan confirmed poorly functioning left kidney (split function 9%), and the patient underwent left simple nephrectomy. Intraoperatively, however, there was a grossly dilated and tortuous left renal pelvis extending all the way up to the bladder with a collapsed short segment of ureter connecting the left renal pelvis to the bladder. Histopathology report was suggestive of Chronic pyelonephritis in a grossly hydronephrotic kidney with UPJO. The patient recovered uneventfully.
Figure 1: Coronal reconstruction of magnetic resonance image and its analogy to an “elephant head”

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   Discussion Top


Giant hydronephrosis due to UPJO in adults, though rare, have been often reported.[1],[2] Almost all of them have grossly dilated pelvis with an obvious distinct ureteropelvic junction with a distal collapsed ureter. With the experience of this case, it can be learnt that a dilated renal pelvis may also undergo tortuous dilatation changes mimicking primary obstructive megaureter. However, whether this UPJO had its origin in lower abdomen before ascent of the kidney or a dilated renal pelvis has pushed the ureteropelvic junction all the way down to the bladder, remains a matter of further research.


   Conclusion Top


Even in today's advanced urological practice with an investigation as advanced as an MRI, intraoperative findings might show up an entirely different picture from the preoperative imaging and may considerably influence the management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship:

Nil.

Conflicts of interest:

There are no conflicts of interest.

 
   References Top

1.
Hu G, Luo M, Xu Y. Giant hydronephrosis secondary to ureteropelvic junction obstruction in adults: Report of a case and review of literatures. Int J Clin Exp Med 2015;8:4715-7.  Back to cited text no. 1
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2.
Wang QF, Zeng G, Zhong L, Li QL, Che XY, Jiang T, et al. Giant hydronephrosis due to ureteropelvic junction obstruction: A rare case report, and a review of the literature. Mol Clin Oncol 2016;5:19-22.  Back to cited text no. 2
[PUBMED]    


    Figures

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