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Zahid M, Nepal P, Nagar A, Batchala PP, Kumar D, Ojili V. Imaging of ureter: a primer for the emergency radiologist. Emerg Radiol 2021; 28:815-837. [PMID: 33851303 DOI: 10.1007/s10140-021-01930-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
In this review article, we will discuss the gamut of abnormalities involving the ureters. In the emergency department, ureterolithiasis is the most common indication for imaging abdomen and pelvis. However, spectrum of ureteral abnormalities including congenital, infectious and inflammatory, primary and secondary ureteral malignancies, retroperitoneal fibrosis rare described in this article may be encountered. Thus, we will describe acute subacute as well as chronic conditions that may affect ureter. Knowledge of common, as well as rare entities and their imaging features, is of utmost importance to enable appropriate management.
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Affiliation(s)
- Mohd Zahid
- Department of Radiology, University of Alabama, Birmingham, AL, USA
| | - Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Devendra Kumar
- Department of Clinical Imaging, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA.
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2
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Sugiura H, Akita H, Kikuchi E, Mikami S, Hayakawa N, Narita K, Jinzaki M. Ureteral pseudodiverticulosis accompanied by urothelial carcinoma diagnosed by CT urography: a case report and review of the literature. BJR Case Rep 2018; 4:20170111. [PMID: 30363136 PMCID: PMC6159122 DOI: 10.1259/bjrcr.20170111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
Ureteral pseudodiverticulosis is a relatively rare condition and has been diagnosed by retrograde urography and excretory urography. Ureteral pseudodiverticulosis is also suspected to be a potential risk factor for the development of urothelial carcinoma. We report the case of a male in his 70 s who was suspected to have right ureteral pseudodiverticulosis accompanied by multifocal urothelial carcinoma based on CT urography findings. After surgery, the pathological findings confirmed the presence of ureteral pseudodiverticulosis and multifocal urothelial carcinoma in his right ureter and bladder. To the best our knowledge, this is the first reported case of ureteral pseudodiverticulosis with concurrent urothelial carcinoma detected by CT urography. Since CT urography has replaced excretory urography as the first-line imaging test for investigating patients with high risk for upper tract urothelial carcinoma, it is important to recognize the characteristic findings of ureteral pseudodiverticulosis on CT urography.
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Affiliation(s)
- Hiroaki Sugiura
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Keiichi Narita
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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3
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Yorita K, Kita Y, Mukai S, Wakeda H, Onizuka C, Tsuzuki T, Kamoto T, Kataoka H, Kuroda N. A novel case presenting with an unusual ureteral diverticular lesion similar to adenomyomatous hyperplasia of the gallbladder. Pathol Int 2016; 66:169-173. [PMID: 27500508 DOI: 10.1111/pin.12383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/25/2015] [Indexed: 11/26/2022]
Abstract
We present the first case of an unusual ureteral diverticular lesion demonstrating similarities to adenomyomatous hyperplasia of the gallbladder. A 68-year-old asymptomatic Japanese man with high prostate-specific antigen levels was clinically evaluated. Left hydronephrosis and benign prostatic hyperplasia were detected. A bilateral retrograde pyelogram revealed that the upper and middle portions of the left ureter exhibited an irregular narrow lumen and some pooling of contrast material, which was compatible with ureteral pseudodiverticulosis. Although no malignant cells were seen on cytology, computed tomography detected a fusiform shaped lesion with a circumferential thick wall including multiple diverticulae. Left nephroureterectomy was performed because malignancy could not be ruled out. Pathology demonstrated that the ureteral lesion showed a localized thick wall consisting of multilocules and/or multicysts and a hyperplastic muscularis propria. The cysts were mostly seen in the muscularis propria or a deeper site. The inner layers of the cysts were lined with normal urothelium, and some cysts opened onto the mucosal surface, indicating that they were derived from invaginated mucosal epithelium. We believe that this lesion may be a novel form of diverticular disorder demonstrating similarities to adenomyomatous hyperplasia of the gallbladder.
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Affiliation(s)
- Kenji Yorita
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuki Kita
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shoichiro Mukai
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hironobu Wakeda
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Chie Onizuka
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toyonori Tsuzuki
- Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi, Japan
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4
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Moosavi B, Fasih N, Virmani V, Kielar A. Beyond ureterolithiasis: gamut of abnormalities affecting the ureter. Clin Imaging 2016; 40:678-90. [PMID: 27317212 DOI: 10.1016/j.clinimag.2016.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 12/08/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022]
Abstract
Nephrolithiasis is the most common condition involving the ureters. However, various other entities can affect the ureters, albeit less frequently. Imaging plays a crucial role in diagnosis, management, and follow-up of ureteral pathology. In the past decade, computed tomography urography has replaced traditional methods of ureteral imaging due to its high spatial resolution, multiplanar imaging, and rapid acquisition time. More recently, magnetic resonance urography has also been explored in evaluating ureteral abnormalities. In this review, we briefly discuss current imaging techniques used in assessment of the ureters and present a diverse group of diseases affecting the ureters. We begin with primary and secondary ureteral malignancies, followed by uncommon infectious/inflammatory diseases that can involve the ureters including tuberculosis, xanthogranulomatous pyelonephritis, and graft-versus-host disease. We then discuss the imaging characteristics of endometriosis and retroperitoneal fibrosis as two important examples of pelvic and retroperitoneal processes that occasionally obstruct the ureters and present with clinical symptoms similar to that of renal stones. We end with a brief discussion of miscellaneous conditions that affect the ureters, including ureteral hemorrhage, ureteral intussusception, ureteral pseudodiverticulosis, Malacoplakia, and ureteritis cystica. Knowledge of these entities and their characteristic imaging manifestations along with patient's clinical presentation allows accurate diagnosis and timely patient management.
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Affiliation(s)
- Bardia Moosavi
- The Ottawa hospital, Department of Radiology Civic Campus, 1053 Carling Avenue, Room C120, Ottawa, ON, K1T4E9.
| | - Najla Fasih
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
| | - Vivek Virmani
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
| | - Ania Kielar
- The Ottawa hospital, Department of Radiology, 501 Smyth Road, Ottawa, ON, K1H 8L6.
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5
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Ureteral pseudodiverticulosis: a unique case diagnosed by multidetector computed tomography. J Comput Assist Tomogr 2009; 33:286-7. [PMID: 19346860 DOI: 10.1097/rct.0b013e318173ebd0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Presented is a case of ureteral pseudodiverticulosis diagnosed by multidetector computed tomography (CT). Axial and coronal reformatted CT images revealed multiple small (2-4 mm) outpouchings of both ureters, characteristic of ureteral pseudodiverticulosis. The unenhanced CT also revealed a 6-mm stone at the left ureterovesical junction and a high attenuation lesion at the right ureterovesical junction suspect for an associated uroepithelial neoplasm.
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Abstract
We describe ureteral diverticula in two dogs and briefly review the related literature. The diagnosis of this condition is radiographic and based on the excretory urographic observation of multiple ureteral outpouchings. Pathologically, ureteral transitional cell hyperplasia and mucinous metaplasia result in submucosal proliferation of the urothelium and the formation of crypts and small cysts. Ureteral diverticulosis in humans is associated with an increased risk of urothelial malignancies, such as transitional cell carcinoma of the urinary bladder. Clinically, both dogs were older, small breed neutered females. Both had a history of chronic urinary obstruction. One dog died during surgery to remove an adrenal mass, and the other was euthanized at the owner's request because of an inoperable bladder neoplasm. Histopathologic diagnosis of ureteral lesions confirmed the radiographic diagnosis of ureteral diverticula in both dogs.
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Affiliation(s)
- S Jakovljevic
- Department of Veterinary Clinical Sciences, Purdue University, School of Veterinary Medicine, West Lafayette, IN 47907, USA
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7
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Wasserman NF. INFLAMMATORY DISEASE OF THE URETER. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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8
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Abstract
Ureteral pseudodiverticula are small outpouchings along the length of the ureter diagnosed primarily by the retrograde urogram. They are associated with hematuria and urinary tract infections, although it is now known whether they cause these associated symptoms or are a result of them. Herein we report 2 cases that highlight the characteristic clinical correlates of ureteral pseudodiverticulosis and review the pertinent literature.
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Affiliation(s)
- S A Socher
- Beth Israel Hospital, Divison of Urology, Harvard Medical School, Boston, Massachusetts, USA
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9
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Comunale L, Baldassarre R, Monaco C, Carluccio G, Poletti G, Schiavone D. Ureteral multiple diverticulosis associateci with cystic ureteritis. Etiopathogenetic hypothesis. Urologia 1992. [DOI: 10.1177/039156039205901s77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Ureteral diverticulosis is an uncommon pathology whose etiopathogenesis is not clear yet. The most reliable etiopathogenetic hypothesis for multiple diverticuli is the inflammatory one. We report a case of ureteral multiple diverticulosis associated with cystic ureteritis: it can be supposed that both pathologies were caused by a common inflammatory stimulus. We submitted the patient to follow-up by urinalysis, urinary citology and urography. At present the appearance of the ureteral lesions is unchanged.
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Affiliation(s)
- L Comunale
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
| | - R. Baldassarre
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
| | - C. Monaco
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
| | - G. Carluccio
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
| | - G. Poletti
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
| | - D. Schiavone
- Cattedra e Divisione Clinicizzata di Urologia - Ospedale Policlinico - Verona
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Parker MD, Rebsamen S, Clark RL. Multiple ureteral diverticula: a possible radiographically demonstrable risk factor in development of transitional cell carcinoma. UROLOGIC RADIOLOGY 1989; 11:45-8. [PMID: 2499972 DOI: 10.1007/bf02926473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Six cases of multiple ureteral diverticula are reported. Most were associated with urinary tract obstruction or stasis and infection. One-third had transitional cell carcinoma, a frequency similar to that reported in previous series. These diverticula are a radiographically demonstrable reflection of urothelial hyperplasia/metaplasia and may represent a risk factor for development of transitional cell carcinoma.
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Affiliation(s)
- M D Parker
- Department of Radiology, University of North Carolina, School of Medicine, Chapel Hill 27514
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11
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Kenney PJ, Wasserman NF. Ureteral pseudodiverticulosis associated with carcinoma of renal pelvis. UROLOGIC RADIOLOGY 1988; 9:161-3. [PMID: 3125646 DOI: 10.1007/bf02932651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe a patient with bilateral ureteral pseudodiverticulosis of 10 years' duration before developing transitional carcinoma of the pelvis.
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Affiliation(s)
- P J Kenney
- Department of Radiology, SUNY Upstate Medical Center, Syracuse
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12
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Yagan R, Lindt H, Shah Z, Bellon EM. Bilateral multiple ureteral diverticula diagnosed after ileal loop procedure: report of a case and review of the literature. J Urol 1985; 133:674-6. [PMID: 3920408 DOI: 10.1016/s0022-5347(17)49140-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report a case of multiple diverticula of the ureter. The clinical and radiological findings of the previously reported 41 cases, including our own, are analyzed, and the microscopic findings of the condition are reviewed. Multiple diverticula of the ureter or ureteral diverticulosis is most likely an acquired condition with a distinct radiological appearance.
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