Presentation
Road traffic accident.
Patient Data
No solid organ injury. No hemoperitoneum or pneumoperitoneum.
Incidental findings of mild right hydronephrosis with dilated right extrarenal pelvis and proximal ureter up to the level of L3/L4 where the right ureter passes posterior to the inferior vena cava (IVC). Normal caliber of the right ureter as it emerges between the IVC and aorta, continuing anterior to the right iliac vessels distally to drain into the urinary bladder.
Normal course of the left ureter.
On excretory phase, there is pooling of contrast within the dilated right ureter. Normal contrast excretion seen from the left kidney into the left ureter and urinary bladder.
Features in keeping with a right circumcaval aorta causing proximal hydroureteronephrosis.
Yellow arrows show the abnormal course of the right ureter passing behind the inferior vena cava (IVC) and emerging between the IVC and aorta. Blue arrows point to the IVC.
Case Discussion
In this patient, the abnormal course of the right ureter was discovered incidentally on CT scan done to evaluate for intra-abdominal injury. Circumcaval ureters are a rare congenital anomaly and are due to developmental anomaly of infra-renal inferior vena cava (IVC). They may cause proximal hydroureteronephrosis due to kinking of the ureter as it passes posterior to the IVC. Symptomatic patients may require surgical intervention.
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