Additional Radiological Imgaging (UTI/VUR)

harn_35a_n.jpg: 13.6-year-old boy with recurrent urinary tract infections and left-sided flank pain. The ultrasound shows a left kidney with grossly normal structure, but which is smaller than the contralateral right kidney and has a blurred limit of the supposed upper pole. harn_35b_n.jpg: MRI with a lateral view of the bladder and the retroperitoneal space. A tube-like structure is visible which becomes smaller in direction of the bladder and continues into a round intravesical structure. harn_35c_n.jpg: MRI with demonstration of both kidneys. The left kidney is smaller, and its upper pole has a structure alteration; above the pelvis of the left kidney, an elogated structure can be seen running to the upper pole. harn_35a_n.jpg to harn_35c_n.jpg: Using the additional radiological imaging of MRI and the confirmation by the operative findings the final diagnosis is complete ureteral duplication of the left side with an infected and pus-containing obstructive cranial megaureter caused by a intravesical ureterocele. The dysplastic and shrunken upper pole of the left kidney was smaller than 1 by 1 cm and had lost its function. In this case the ultrasound of the retroperitoneal space showed a dilated prevesical ureter and the IVU a rounded space-occupying mass in the bladder, and a temporary reflux in an undilated contralateral ureter. It was possible to add all these findings to the above mentioned diagnosis only by an MRI. Since the surgery with complete resection of the ureter, the patient hasn't had any symptoms and signs. In special cases the MRI may be very useful for the evaluation of structure, dimension, and pathotopographical relation of the renal and ureteral structures in ureteral duplication. The case also illustrates the necessity of the combined excision of the corresponding ureter.