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Antegrade MDCT Pyelography for the Evaluation of Patients with Obstructed Urinary Tract

Eduard Ghersin1, Olga R. Brook1, Shimon Meretik2, Joseph K. Kaftori1, Amos Ofer1, Marco A. Amendola3 and Ahuva Engel1

1 Department of Diagnostic Imaging, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel.
2 Department of Urology, Rambam Medical Center, Haifa 31096, Israel.
3 Department of Radiology, University of Miami, Miami, FL 33136.



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  		Fig. 1A. —68-year-old man after percutaneous nephrostomy due to left hydronephrosis. Conventional antegrade pyelogram shows ureteral obstruction in lower ureter (arrow) without filling defects or wall irregularity.

 


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  		Fig. 1B. —68-year-old man after percutaneous nephrostomy due to left hydronephrosis. Thin-slab sagittal (B) and curved multiplanar (C) reformations depict two lesions in lower ureter (arrows), focal thickening of posterior wall, and filling defect of soft-tissue density. These lesions correlated with surgical and histopathologic findings of multifocal transitional cell carcinoma of lower ureter.

 


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  		Fig. 1C. —68-year-old man after percutaneous nephrostomy due to left hydronephrosis. Thin-slab sagittal (B) and curved multiplanar (C) reformations depict two lesions in lower ureter (arrows), focal thickening of posterior wall, and filling defect of soft-tissue density. These lesions correlated with surgical and histopathologic findings of multifocal transitional cell carcinoma of lower ureter.

 


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  		Fig. 2A. —71-year-old man after percutaneous nephrostomy due to right hydronephrosis with history of invasive bladder transitional cell carcinoma. Axial CT scan obtained at level of ureterovesical junction after right antegrade MDCT pyelography shows small exophytic bladder mass (dotted arrow) that involves medial wall of distal right ureter. Residual ureteral lumen (solid arrows) is opacified after injection of contrast material through nephrostomy catheter.

 


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  		Fig. 2B. —71-year-old man after percutaneous nephrostomy due to right hydronephrosis with history of invasive bladder transitional cell carcinoma. IV-contrast-enhanced standard abdominal axial CT scan after oral contrast material administration at parallel anatomic position obtained 6 weeks after A depicts enlargement of exophytic bladder mass without delineation of distal ureteral lumen due to delayed contrast excretion. Note normal left ureterovesical junction (short solid arrow).

 


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  		Fig. 3A. —65-year-old man 6 months after radical cystectomy with ileal conduit due to invasive bladder transitional cell carcinoma. Previous loopogram and sonogram (not shown) failed to opacify left ureter and renal collecting system and showed moderate left hydronephrosis, respectively. Antegrade MDCT pyelogram was obtained through biliary sheath needle (arrow) placed in left renal collecting system under CT guidance.

 


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  		Fig. 3B. —65-year-old man 6 months after radical cystectomy with ileal conduit due to invasive bladder transitional cell carcinoma. Previous loopogram and sonogram (not shown) failed to opacify left ureter and renal collecting system and showed moderate left hydronephrosis, respectively. In right pelvis, left hydroureter is visible because of soft-tissue mass (dotted black arrow) at anastomosis between distal left ureter (dotted white arrow) and ileal conduit (solid white arrow). Also, small fluid collection is seen posterior to anastomotic mass, probably representing small urinoma (solid black arrow). Findings are consistent with local tumor recurrence.

 


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  		Fig. 4A. —20-year-old man with mild renal failure (creatinine level, 1.7 mg/dL) and sonographic evidence of marked right hydronephrosis and hydroureter associated with left renal agenesis (not shown). Antegrade MDCT pyelography was performed through biliary sheath needle placed in right renal collecting system under CT guidance. Volume-rendered reformation depicts increased number of calyces with absent calyceal cupping (solid arrow) and abnormally dilated convoluted ureter (dotted arrow).

 


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  		Fig. 4B. —20-year-old man with mild renal failure (creatinine level, 1.7 mg/dL) and sonographic evidence of marked right hydronephrosis and hydroureter associated with left renal agenesis (not shown). Antegrade MDCT pyelography was performed through biliary sheath needle placed in right renal collecting system under CT guidance. Curved multiplanar reformation shows markedly dilated ureter with smoothly tapered narrowing of its intravesical portion (arrow). Findings are consistent with congenital megaureter and megacalyces.

 


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  		Fig. 5A. —49-year-old woman after bilateral percutaneous nephrostomy due to severe hydronephrosis and renal failure. Thick-slab coronal multiplanar reformation depicts bilateral medial deviation with focal narrowing of both mid ureters at level of L4–L5 (arrow).

 


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  		Fig. 5B. —49-year-old woman after bilateral percutaneous nephrostomy due to severe hydronephrosis and renal failure. Thin-slab curved multiplanar reformations projected in coronal (B) and sagittal (C) planes depict marked focal luminal narrowing of right ureter (white arrows) caused by discrete retroperitoneal plaque (black arrow, C). Findings are consistent with idiopathic retroperitoneal fibrosis and were confirmed on contrast-enhanced CT and MRI (not shown).

 


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  		Fig. 5C. —49-year-old woman after bilateral percutaneous nephrostomy due to severe hydronephrosis and renal failure. Thin-slab curved multiplanar reformations projected in coronal (B) and sagittal (C) planes depict marked focal luminal narrowing of right ureter (white arrows) caused by discrete retroperitoneal plaque (black arrow, C). Findings are consistent with idiopathic retroperitoneal fibrosis and were confirmed on contrast-enhanced CT and MRI (not shown).

 

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