Wednesday, July 21, 2010

Ureterocele with ureteric jet:

Does a ureterocele prevent urine entering into the urinary bladder? This Color Doppler ultrasound image proves that ureteroceles may not always produce ureteral obstruction. Despite the large size of the outpouching of the distal end of the ureter seen in this image, there is a powerful jet of urine being pumped into the urinary bladder (the urine jet is seen as a colored column in the bladder). For more images on this topic see:
This color Doppler ultrasound image is courtesy of Dr. Prasenjeet Singh, MD, India.
And here is another case- a middle aged female patient with pain in the left iliac region:
Grey scale ultrasound image shows a small right ureterocele:
In addition there is a mild hydronephrosis of the right kidney.

This ultrasound video clip confirms the right ureterocele. Very often such an appearance can be mistaken for mucosal edema around a recently passed vesico-ureteric junction calculus. But this is ruled out ---

 There is no mistaking the small bulging vesicle (bubble) of the right ureterocele that measures about 9 mm. at maximum width; gradually collapsing as it empties.

This color Doppler video clip (below) shows normal flow (ureteral or ureteric jet) from the left ureteric orifice. However there is very poor flow from the right ureteric orifice (due to the ureterocele). This is in direct contrast to the case -1 above, where the ureterocele does not cause significant obstruction, despite its large size. 
Moral: size does not always matter when it comes to ureteroceles!!
CASE- 3:
Here is another example of a moderately large right ureterocele, with an almost normal right ureteric urine jet:
I posted this gray scale ultrasound video clip on you tube for better clarity and resolution of the video clip:

And here is the color Doppler video clip of the same case, posted by me on you tube:

This ultrasound image shows both normal kidneys, a clear sign that there is little by way of obstruction to the flow of urine on the side of the ureterocele.

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