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Radiology.Academy.Sk

Pelvicaliectasis

Uretero-Pelvic Junction Obstruction (UPJ)


Is the most common cause of pelvicaliectasis w/o associated ureteral dilatation. Usually diagnosed prenatally. Most common congenital obstruction of the urinary tract. 1:1000, Boys > Girls, Left > Right, may coexist w/ VUR, Uretero-Vesical Junction (UVJ) Obstruction, MCDK


Crossing vessel


Segmental lower pole renal artery or vein may cross UPJ and cause "vascular UPJO": (intermitent hydronephrosis found usually in older children)

Imaging: US, VCUG, Scintigraphy in infants


Ultrasound


Degree of dilation


The Society for Fetal Urology - SFU - US grading system for postnatal hydronephrosis



Voiding CystoUrethroGram (VCUG)


To determine if hydronephrosis is due to UPJ obstruction or VUR or both and asses contralateral upper urinary tract because there is frequently contralateral VUR with UPJO. UPJO can also coexist w/ ipsilateral VUR as demonstrated by dilution of contrast as it enters pelvis, suggesting there was an unopacified urine before the study begun. Delayed images will show retention of contrast above UPJ.


RNS: Radionuclide Scintigraphy - 99mTc labelled Mercaptoacetyltriglycine (99mTc-MAG3) followed by Lasix. Follow pts for progression, stability or resolution of UPJO.


CT/MRI: incidental findings of pelvicaliectasis or extrarenal pelvis, not a first study to get, order, US+VCUG; good for vascular UPJO - crossing artery


TH: prophylactic abx, surgery (Hynes-Anderson pyeloplasty) or nephrectomy
Postoperative imaging: 6 wks after, US, RNS, IVU (intravenous urography)