OBGY Radiology
Case 6 :
A 32-year-old female with right pelvic pain. A transvaginal ultrasound performed in the gynecologist’s clinic revealed a lobulated cystic lesion in the pelvis, suggestive of a right ovarian cyst. Laparoscopy showed no cystic mass lesion, with normal ovaries and uterus. CT scan of pelvis was performed. 
What is the diagnosis?
  
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Imaging Findings

 Study shows a lobulated low attenuation lesion seen in the pelvis, sections were extended beyond the pelvis, and this cystic “mass” was seen extending into the upper moiety of right kidney. A “cobra-head” appearance of ureterocele was seen in the urinary bladder on the right. Lower moiety of right kidney showed normal function. No ovarian mass was detected.

 Diagnosis 

Congenital megaloureter with ureterocele in a duplex right kidney.

 Discussion

 The term megaloureter is usually reserved for cases of congenital dilatation of the ureter when there is no organic obstruction or vesico-ureteric reflux. In some patients, the bladder capacity may be markedly distended (megaloureter-megacystis syndrome). No organic obstruction is usually demonstrable, and a ureteric catheter can be passed usually without any great difficulty.

Cause of this condition is not known but it has been suggested that the functional obstruction at the uretero-vesical junction is the result of abnormal arrangement of the circular fibers of the ureteric musculature. Stasis in a megaloureter may predispose to infection or stone formation.

 Contribution

 Dr. Nikhil Cunha, Mumbai