|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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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.
Congenital megaloureter with ureterocele in a duplex
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.
Dr. Nikhil Cunha, Mumbai