URINARY Section 9: URETER Flashcards
tones tend to lodge in 3 spots:
UPJ
Pelvic Brim
UVJ
Wall calcifications should make you think about
two things:
- TB
- Schistosomiasis
Numerous tiny subepithelial fluid-filled cysts within the wall of the ureter
Ureteritis cystica
The condition is the result of chronic inflammation (from stones and/or chronic infection).
Typically this is seen in diabetics with recurrent UTI. There may be an increased risk of cancer.
Ureteritis cystica
Ureteritis Cystica
“these guys are multiple small outpouchings.”
they are bilateral 75% of the time, and favor the upper and middle third. There is an association with malignancy.
Malakoplakia
“Soft tissue nodularity / plaques in the bladder and ureters (bladder more often)”
Chronic UTI (E.coli) + Immunocompromised patiets
Malakoplakia
malakoplakia most frequently manifests as
a mucosal mass involving the ureter or bladder
the most common renal finding in Malakoplakia
obstruction secondary to a lesion in the lower tract.
Michaelis-Gutmann Bodies
Malakoplakia
squamous metaplasia secondary to chronic irritation (stones or infections). The bladder is more commonly involved than the ureter.
Leukoplakia
Premalignant inflammation
Malakoplakia vs Leukoplakioa
Leukoplakia = Premalignant (Squamout Cell CA NOT transitional cell)
Malakoplakia = NOT Premalignant
This condition is characterized by proliferation of aberrant fibro-inflammatory tissue, which typically surrounds the aorta, IVC, iliac vessels, and frequently traps and obstructs the ureters.
Retroperitoneal Fibrosis
“Ormond Disease”
Retroperitoneal Fibrosis
Retroperitoneal firbsosis assiciated disorders
IgG4 disorders (autoimmune pancreatitis,
Riedel’s thyroiditis,
inflammatory pseudotumor)
Classically shown with medial deviation of ureters
Retroperitoneal Fibrosis
This tends to occur in patients on long-term anticoagulation or a history of hemophilia.
Subepitheiiai Renal Pelvis Hematoma:
Classic mimic of Transitional Cell Carcinoma
Subepitheiiai Renal Pelvis Hematoma
thickened upper tract wall
Subepitheiiai Renal Pelvis Hematoma
“hyperdense clot on the pre-contrast that does NOT enhance. “
blood in urinary pelvis + hemophilia =
Subepitheiiai Renal Pelvis Hematoma:
Lateral Deviation of the Ureters
Retroperitoneal Adenopathy
Aortic Aneurysm
Psoas Hypertrophy (proximal ureter)
Medial Deviation “Waisting” of the Ureters
Retroperitoneal Fibrosis
Retrocaval Ureter (right side)
Pelvic Lipomatosis
Psoas Hypertrophy (distal ureter)
