2. A 14 year old male presented with a three months
history of right flank pain that was of sudden
onset and initially colicky but had become
constant.

3.  Full blood count, urinalysis and blood urea and
creatinine were normal.
 No evidence of hematuria.

4.  Abdominal ultrasonography revealed a right
hydronephrosis.
 An intravenous pyelography showed delayed
function of the right kidney and subsequently a
right hydronephrosis and hydroureter of the
proximal ureter with non-visualization of the
rest of the right ureter.

6. Diagnosis?

7. Also known as “circumcaval ureter”
Ureter courses posterior to the inferior vena cava
Incidence
 0.07%
 Male to female ratio of 3:1

8. Abnormality in embryogenesis of IVC
 Results from abnormal persistence of right
subcardinal vein positioned ventral to ureter in the
definitive IVC
 Developing right ureter courses behind and medial
to the IVC

9. Symptoms of right ureteral obstruction
Right flank pain
Hydronephrosis
Pylonephritis
fever

12.  Right ureter’s course swings medially over
pedicle of L3/4
 Passes behind IVC
 Then exits anteriorly between IVC and aorta
returning to its normal position
 Produces varying degrees of proximal
hydroureteronephrosis

14.  Abdominal ultrasoundAbdominal ultrasound demonstrates
hydronephrosis.
 IVUIVU does not demonstrate the middle and
distal ureter requiring a retrograde
ureteropyelogram to demonstrate the ureter
and hence confirm the diagnosis.

15.  Spiral CTSpiral CT define the ureter and inferior vena
cava anomalies obviating the need for a
retrograde ureteropyelogram and is considered
an investigation of choice.
 MRIMRI demonstrate the course of a pre-ureteral
vena cava a more detailed and less invasive
imaging modality, without exposure to
radiation

28. Thank You