Paediatric Radiology


 
Case  9 :  

Post-natal scan of a day-old neonate.

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Fig 1 (Right Kidney)

Fig 2 (Orifice 1 & Orifice 2)

 


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USG shows a hydronephrotic upper moiety of the right kidney (Fig 1). Color Doppler
study shows a reversal of color, indicating vesico-ureteric reflux (Fig 2).
 

Diagnosis
Duplex collecting system of the kidney with VU reflux 

Discussion
Duplex collecting system is the most common congenital anomaly of the urinary tract.
Duplication can be complete (2 ureters with two separate ureteral orifices) and
incomplete (when ureters join and enter the bladder together in a single ureteric orifice).
As a general rule, the upper moiety (ectopic ureter) is prone for formation of ureterocele
(with or without VU reflux), while the lower moiety is prone for VU reflux.
 

VU Reflux on Color Doppler
Ureteral jets are easily perceptible by CD imaging. For demonstration of reflux, the
patient should be adequately hydrated. The ureteral orifice should be located in the
urinary bladder by real time imaging, and the scan plane should be so adjusted so that
the lower ureter is seen entering the urinary bladder (lengthwise imaging). The ureteral jet
 should then be observed on CD imaging. Adult patients and co-operative children should
be instructed to perform the Valsalva’s manouevre immediately after the jet is observed.
Infants can be scanned when they are crying. Reversal of flow indicated VU reflux.

 

Dr. Alpana Joshi, Associate Professor, BYL Nair Hospital, Mumbai