Multi-Modality imaging allows for a more accurate diagnosis, resulting in optimal treatment of patients.
A 4 month old male required assessment because of an antenatal diagnosis of hydronephrosis detected on ultrasound examination. The patient was referred for a Mag III study to assess for the presence of obstruction. The scan demonstrated a poorly functioning right kidney and a dilated left pelvi-calyceal system which drained. A round photon deficient area was identified in the bladder base, indicative of a ureterocele. Delayed images revealed greater activity in a dilated right pelvi-ureteric system when compared to the early images. This finding was most likely explained by vesico-ureteric reflux (VUR).
A ureterocele was not identified on the previous ultrasound but confirmed on a subsequent cystogram, which also demonstrated reflux into the dilated right ureter, which was suspected on the Mag III study. As a result of these findings, the patient underwent an early incision of the ureterocele to relieve obstruction and preserve renal function. A follow up Mag III study confirmed reduced dilatation of both pelvi-ureteric systems following this intervention.
An intravesical ureterocele is a congenital disorder in which the ureter balloons at the distal end at the site of entry of the ureter into the bladder. It results in obstruction and subsequent loss of function. Thus early intervention is critical.
In this instance a combination of various imaging techniques including sonography, radiology and nuclear medicine allowed for the fast accurate diagnosis of the pathology and resulted in early appropriate treatment.