J Korean Soc Radiol.  2013 Feb;68(2):137-140. 10.3348/jksr.2013.68.2.137.

Case Report of Left Retrocaval Ureter: Pre-Transplant CT Urographic Findings and Post-Transplant Outcomes

• Kim AY
• Park BK
• Kim CK
• Park SY
• Han DH

• KMID: 2097991
• DOI: http://doi.org/10.3348/jksr.2013.68.2.137

Abstract

A left retrocaval ureter is an extremely rare congenital anomaly, in which the left ureter passes behind the left inferior vena cava (IVC). The compression of the ureter between the IVC and the vertebrae results in a progressive hydronephrosis. Recently, the left kidney with a retrocaval ureter was detected on CT urographic images in a living-related donor and achieved a good outcome after allograft transplantation. We report the CT urographic findings of a left retrocaval ureter and the short-term outcome of allograft transplantation.

MeSH Terms

Humans
Hydronephrosis
Kidney
Kidney Transplantation
Spine
Tissue Donors
Transplantation, Homologous
Transplants
Ureter
Vena Cava, Inferior

Figure

• 

  Fig. 1 A 24-year-old man (donor) with a left retrocaval ureter. A. Excretory phase CT urographic axial image shows a left ureter (black arrowheads) passing behind the left inferior vena cava (IVC) (white arrow). It is severely dilated due to the compression between the IVC and the lumbar vertebra. White arrowheads and a black arrow indicate right ureter and right IVC, respectively. B. Excretory phase CT urographic coronal image shows a left ureter (white arrowheads) that appears normal in front of the left IVC as compared to dilated proximal left ureter (asterisk). Black arrowheads indicate right ureter. C. Maximum intensity projection reconstructed image demonstrates a characteristic hairpin turn ("J" shape deformity) of the left ureter (arrowheads), leading to the diagnosis of a left retrocaval ureter.

Reference

1. Ishitoya S, Arai Y, Waki K, Okubo K, Suzuki Y. Left retrocaval ureter associated with the Goldenhar syndrome (branchial arch syndrome). J Urol. 1997. 158:572–573.

2. Rubinstein I, Cavalcanti AG, Canalini AF, Freitas MA, Accioly PM. Left retrocaval ureter associated with inferior vena caval duplication. J Urol. 1999. 162:1373–1374.

3. Sebastià C, Quiroga S, Buñesch L, Boyé R, Salvador R, Nicolau C. Usefulness of computed tomography performed immediately after excretory urography in patients with delayed opacification or dilated upper urinary tract of unknown cause. Abdom Imaging. 2012. 37:482–493.

4. Talwar R, Sinha T, Varma PP, Karan SC, Sandhu AS, Sethi GS, et al. Transplantation of kidney with retrocaval ureter: what are the pitfalls? Nephrol Dial Transplant. 2006. 21:230–231.

5. Costea F, Pontin AR, Botha JF, Halkett JA, Kahn D. Renal transplantation from a living related donor with a retrocaval ureter--a note of caution. Transpl Int. 1999. 12:229–230.

6. Pienkny AJ, Herts B, Streem SB. Contemporary diagnosis of retrocaval ureter. J Endourol. 1999. 13:721–722.

7. Rao KG. Case profile: retrocaval ureter. Urology. 1975. 6:385.

8. Lin WC, Wang JH, Wei CJ, Chang CY. Assessment of CT urography in the diagnosis of urinary tract abnormalities. J Chin Med Assoc. 2004. 67:73–78.

9. Yong Y, Yi H, Gang J. A retrocaval ureter. Lancet. 2010. 375:1029.

10. Chou CT, Yang AD, Hong YC, Wu HK. Bilateral retrocaval ureters with IVC duplication. Abdom Imaging. 2006. 31:596–597.