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Interiliac Ureter: A Rare Venous Anomaly Causing Hydronephrosis
Accepted Manuscript Title: Interiliac Ureter: a Rare Venous Anomaly Causing Hydronephrosis Author: Priyank Yadav, Hira Lal, Devarshi Srivastava, Pankaj Gaur PII: DOI: Reference:
S0090-4295(16)30638-0 http://dx.doi.org/doi: 10.1016/j.urology.2016.09.027 URL 20043
To appear in:
Urology
Received date: Accepted date:
7-7-2016 14-9-2016
Please cite this article as: Priyank Yadav, Hira Lal, Devarshi Srivastava, Pankaj Gaur, Interiliac Ureter: a Rare Venous Anomaly Causing Hydronephrosis, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.09.027. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
TITLE: Interiliac ureter: a rare venous anomaly causing hydronephrosis.
TYPE OF ARTICLE: Images in clinical urology
AUTHORS Priyank Yadava, Hiralalb, Devarshi Srivastavaa, Pankaj Gaura a
Department of Urology and Renal transplantation, SGPGIMS, Raibareli road, Lucknow, India b
Department of Radiology, SGPGIMS, Raibareli road, Lucknow, India
CORRESPONDING AUTHOR Dr Hiralal Additional professor, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow – 226014, India Email – [email protected] Telephone Number - +91-522-2494110 Fax - +91-522-2668017
WORD COUNT ABSTRACT: 75 MAIN TEXT: 199
ABSTRACT
Page 1 of 4
Most of the developmental anomalies of inferior vena cava are asymptomatic. The retrocaval and retroiliac ureter however, commonly present with symptoms due to ureteric obstruction. We present interesting computed tomography images of a 30-year old male who was symptomatic for right upper ureteric obstruction and the ureter was coursing between the two common iliac veins that were uniting abnormally high at the level of right renal hilum with absence of infrarenal inferior vena cava.
KEYWORDS: Hydronephrosis, Interiliac ureter, IVC anomaly
ACKNOWLEDGEMENTS None
TEXT A 30-year old male presented with intermittent dull aching right flank pain for one year. Ultrasonography revealed moderate hydroureteronephrosis on the right side. CT urography suggested a high union of common iliac veins at the level of right renal hilum (Fig. 1). The right ureter had an abnormal course passing between the two common iliac veins at the level of fourth lumbar vertebra (Fig. 2). There was no single infrarenal inferior vena cava (IVC). The suprarenal IVC had a normal course (Fig.3). As the diuretic renal scan showed non-obstructive drainage, the patient opted against surgery (laparoscopic right ureteroureterostomy).
Page 2 of 4
IVC develops from paired subcardinal, supracardinal and posterior cardinal veins and abnormal development of any one or more of these could give rise to IVC anomaly. 1 The commonest of these include circumaortic and retroaortic left renal vein. 2A retrocaval ureter has an incidence of 0.1% and has been reported in association with duplication of the infrarenal IVC where one IVC is present on either side of the aorta. 3
The infrarenal IVC may be congenitally short, originating as high as the third lumbar
vertebra. 4An absent infrarenal IVC associated with a high retroiliac ureter (or an interiliac ureter) has not been reported.
REFERENCES 1) Petik B. Inferior vena cava anomalies and variations: imaging and rare clinical findings. Insights Imaging. 2015;6(6):631-9. 2) Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000;20(3):639-52. 3) Dudekula A, Prabhu SD. A Rare Case of Right Retrocaval Ureter with Duplication of Infrarenal IVC. Case Rep Radiol. 2014;2014:345712. 4) Appaji AC, Kulkarni R. Level of Bifurcation of Aorta and Iliocaval Confluence and Its Clinical Relevance. IOSR-JDMS2014;13(7):56-60.
FIGURE LEGENDS
Page 3 of 4
Fig.1: Axial contrast enhanced CT (nephrographic phase) at the level of right renal hilum showing the two common iliac veins just prior to formation of IVC (arrow).
Fig.2: (A) Axial contrast enhanced CT showing compressed ureter between the two common iliac veins, (B) CT Urography in axial plane showing compressed ureter at the same level with proximal hydroureteronephrosis, (C) Volume rendered image of CT Urography in coronal plane showing hydroureteronephrosis proximal to the upper border of fourth lumbar vertebra on the right side.
Fig.3: CECT image in coronal plane showing the normal suprarenal IVC course (*). The dilated right renal pelvis and upper ureter are also seen (arrow).
Page 4 of 4
S0090-4295(16)30638-0 http://dx.doi.org/doi: 10.1016/j.urology.2016.09.027 URL 20043
To appear in:
Urology
Received date: Accepted date:
7-7-2016 14-9-2016
Please cite this article as: Priyank Yadav, Hira Lal, Devarshi Srivastava, Pankaj Gaur, Interiliac Ureter: a Rare Venous Anomaly Causing Hydronephrosis, Urology (2016), http://dx.doi.org/doi: 10.1016/j.urology.2016.09.027. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
TITLE: Interiliac ureter: a rare venous anomaly causing hydronephrosis.
TYPE OF ARTICLE: Images in clinical urology
AUTHORS Priyank Yadava, Hiralalb, Devarshi Srivastavaa, Pankaj Gaura a
Department of Urology and Renal transplantation, SGPGIMS, Raibareli road, Lucknow, India b
Department of Radiology, SGPGIMS, Raibareli road, Lucknow, India
CORRESPONDING AUTHOR Dr Hiralal Additional professor, Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow – 226014, India Email – [email protected] Telephone Number - +91-522-2494110 Fax - +91-522-2668017
WORD COUNT ABSTRACT: 75 MAIN TEXT: 199
ABSTRACT
Page 1 of 4
Most of the developmental anomalies of inferior vena cava are asymptomatic. The retrocaval and retroiliac ureter however, commonly present with symptoms due to ureteric obstruction. We present interesting computed tomography images of a 30-year old male who was symptomatic for right upper ureteric obstruction and the ureter was coursing between the two common iliac veins that were uniting abnormally high at the level of right renal hilum with absence of infrarenal inferior vena cava.
KEYWORDS: Hydronephrosis, Interiliac ureter, IVC anomaly
ACKNOWLEDGEMENTS None
TEXT A 30-year old male presented with intermittent dull aching right flank pain for one year. Ultrasonography revealed moderate hydroureteronephrosis on the right side. CT urography suggested a high union of common iliac veins at the level of right renal hilum (Fig. 1). The right ureter had an abnormal course passing between the two common iliac veins at the level of fourth lumbar vertebra (Fig. 2). There was no single infrarenal inferior vena cava (IVC). The suprarenal IVC had a normal course (Fig.3). As the diuretic renal scan showed non-obstructive drainage, the patient opted against surgery (laparoscopic right ureteroureterostomy).
Page 2 of 4
IVC develops from paired subcardinal, supracardinal and posterior cardinal veins and abnormal development of any one or more of these could give rise to IVC anomaly. 1 The commonest of these include circumaortic and retroaortic left renal vein. 2A retrocaval ureter has an incidence of 0.1% and has been reported in association with duplication of the infrarenal IVC where one IVC is present on either side of the aorta. 3
The infrarenal IVC may be congenitally short, originating as high as the third lumbar
vertebra. 4An absent infrarenal IVC associated with a high retroiliac ureter (or an interiliac ureter) has not been reported.
REFERENCES 1) Petik B. Inferior vena cava anomalies and variations: imaging and rare clinical findings. Insights Imaging. 2015;6(6):631-9. 2) Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000;20(3):639-52. 3) Dudekula A, Prabhu SD. A Rare Case of Right Retrocaval Ureter with Duplication of Infrarenal IVC. Case Rep Radiol. 2014;2014:345712. 4) Appaji AC, Kulkarni R. Level of Bifurcation of Aorta and Iliocaval Confluence and Its Clinical Relevance. IOSR-JDMS2014;13(7):56-60.
FIGURE LEGENDS
Page 3 of 4
Fig.1: Axial contrast enhanced CT (nephrographic phase) at the level of right renal hilum showing the two common iliac veins just prior to formation of IVC (arrow).
Fig.2: (A) Axial contrast enhanced CT showing compressed ureter between the two common iliac veins, (B) CT Urography in axial plane showing compressed ureter at the same level with proximal hydroureteronephrosis, (C) Volume rendered image of CT Urography in coronal plane showing hydroureteronephrosis proximal to the upper border of fourth lumbar vertebra on the right side.
Fig.3: CECT image in coronal plane showing the normal suprarenal IVC course (*). The dilated right renal pelvis and upper ureter are also seen (arrow).
Page 4 of 4