circumcaval ureter

Circumcaval
ureter - Congenital vascular cause of obstructive hydronephrosis. 25-year-old male patient with right circumcaval ureter showing the right ureter (green arrows) encircling the IVC (blue arrow). Right kidney also shows mild hydronephrosis.
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Teenager with
right flank pain when drinking large amounts of soda pop. AP image from the excretory phase of a vintage intravenous pyelogram (left) shows a normal left renal collecting system and left ureter and an extremely dilated right renal collecting system. Magnified views of the right ureteropelvic junction (right above and right below) show a sharp kink at the right ureteropelvic junction.The diagnosis was retrocaval ureter causing right ureteropelvic junction obstruction.
pediatricimaging.org • CC-by-nc-sa 4.0
Circumcaval
ureter - Congenital vascular cause of obstructive hydronephrosis. 25-year-old male patient with right circumcaval ureter showing medial deviation of the right ureter at L3 level with hydroureteronephrosis with a ‘reverse J’ configuration.
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Circumcaval
ureter - Congenital vascular cause of obstructive hydronephrosis. 25-year-old male patient with right circumcaval ureter showing the right ureter (green arrows) encircling the IVC (blue arrow). Right kidney shows a ‘reverse J’ configuration of proximal dilated ureter up to the L3 level.
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Ureter encircling the IVC.
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Ureter encircling the IVC.
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Medial displacement of the ureter, with S shaped at the level of L3
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Maximum intensity projection (MIP) in coronal reconstruction showing the S configuration of the proximal ureter at the level of L3
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Non-dilatated ureter (arrow) emerges between the aorta and the IVC.
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Retrocaval
ureter: a congenital cause of right ureteral obstruction. Abdominal x-ray done after the contrast CT, showing opacification of the excretory system, dilated on the right side with the S configuration at the level of L3. Its also possible to see the heart normodimensionated.
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Radiopaedia • CC-by-nc-sa 3.0 • de

Circumcaval ureter, also known as retrocaval ureter, is a term used to describe an abnormal course of a ureter that encircles the inferior vena cava. Both of these terms are somewhat misleading, as this configuration is considered a developmental anomaly of the inferior vena cava (IVC). There are two types:

  • low loop (type 1)
  • high loop (type 2)

Clinical presentation

Many patients with this anomaly are asymptomatic. Depending on the degree of compression patients may develop partial right ureteral obstruction or recurrent urinary tract infections due to urinary stasis.

Pathology

This congenital abnormality occurs as a result of the right supracardinal system failing to develop normally. The right posterior cardinal vein persists, and therefore ends up passing in front of the ureter.

With one reported exception, the anomaly always occurs on the right side, as this is the side of the normal IVC.

Radiographic features

The proximal ureter courses posterior to the IVC, then emerges to the right of the aorta, coming to lie anterior to the right iliac vessels. Any chosen imaging modality will usually show a right hydroureteronephrosis above the segment embracing the IVC. Intravenous urogram classically depicts a fishhook-shaped or S-shaped deformity of the ureter in type 1 or the low loop variety.  In type 2, the retrocaval segment is at the same level as the renal pelvis; the sickle-shaped appearance of the involved ureter can be identified on IVU. Type 2 generally causes mild hydronephrosis and is less common than type 1.

Treatment and prognosis

If treatment is required, surgical relocation of the ureter anterior to the IVC can be performed.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu retrocavaler Verlauf des Ureters:
Varianten der
Vena cava inferior
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Anomalien des
Ureters
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Anomalien des
urogenitalen Systems
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