This woman presented with chronic pelvic and bilateral loin pain, which had cyclical variability. Microscopic haematuria was also noted.
1. Describe the findings on this image taken as part of an intravenous urogram.
2. Suggest a differential diagnosis and further investigations
.
Answers to Case 1-10
1.This Figure is a postcontrast image from an IVU series showing smoothly narrowed
distal ureters with dilatation of the more proximal ureters and pelvicalyceal
systems. Contrast still passes into the bladder i.e. appearances are in
keeping with partial obstruction. The upper tracts are dilated but otherwise normal.
This patient proved to have bilateral endometriosis.
2. The smoothness of the mucosal outline of the strictures would suggest an extra
luminal mass of benign aetiology. Possible causes are endometriosis, post radiation,
retroperitoneal fi brosis, extra-luminal compression by pelvic masses (e.g.
ovarian cysts) pelvic infl ammatory disease, lymphadenopathy, collections or
ischaemic strictures following pelvic surgery. Further investigations that may
help are CT/MRI +/− biopsy. Ureteroscopy is unlikely to contribute other than to
confi rm the strictures, but occasionally the nodules of endometriosis may be seen
in the wall. The diagnosis is often made at diagnostic laparoscopy.