VASCULAR IMPRESSIONS ON THE URETERS

¹ 467 N. E. 55th Terrace, Miami, Florida 33137.
² Department of Radiology, Peter Bent Brigham Hospital, 25 Shattuck Street, Boston, Massachusetts 02115.

Impressions upon the ureters accounted for by extrinsic pressure defects exerted by adjacent or crossing arteries and veins are frequently noted on urographic studies. The observation of these extrinsic pressure defects is usually made, but their significance is often overlooked. We have discussed and illustrated those conditions which may result in ureteral notching on an arterial and venous basis.

The arterial causes of ureteral impressions include:

1. impressions by accessory but normal renal arteries;

2. compression by a normal iliac artery;

3. renal artery stenosis;

4. aortic and iliac artery occlusion;

5. cirsoid aneurysm of the renal artery;

6. impression by aortic and hypogastric artery aneurysm.

The venous impressions on the ureters may be due to:

1. normal gonadal vein crossing defect on right or on left;

2. right ovarian vein syndrome;

3. varicocele and varices of the broad ligament;

4. occlusion of the inferior vena cava below the level of the renal veins by tumor, clot, retroperitoneal fibrosis, or following caval division as part of a surgical procedure;

5. occlusion of the inferior vena cava above the level of the renal veins due to thrombosis or tumor;

6. renal vein occlusion by thrombosis, hypernephroma, malignant disease metastatic to the area of the renal vein or by direct extension of retroperitoneal tumor;

7. occlusion of the azygos vein by tumor;

8. occlusion of the superior vena cava by tumor;

9. portal hypertension;

10. carcinoma of the pancreas.

We do not feel that the long differential diagnosis usually appended to case reports of ureteral notching is a realistic one. The only real differential diagnostic problem is that of retroperitoneal tumor or lymph nodes. With this one exception, vascular impressions on the ureters should be recognized as such. However, the choice among the large number of possible vascular defects may be difficult or impossible on the basis of urography alone. The proper angiographic study, chosen on the basis of all available clinical and roentgenographic information, will usually supply the diagnosis.

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