Internal Medicine

0521779407-21 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:59

1486 Upper Urinary Tract Obstruction

➣Congenital ureteropelvic or ureterovesical junction obstruction

➣Secondary to ureteral injury or previous surgery

Extrinsic Obstruction

■Retroperitoneal disease

➣Idiopathic fibrosis

Insidious, dull, back/flank pain

Elevated ESR

IVU or CT urogram: medial deviation of ureters

CT: confluent fibrotic mass encasing great vessels and ureters

from level of renal vessels to bifurcation of great vessels

➣Tu m o r

IVU: ureter deviated laterally

CT: retroperitoneal mass

➣Abscess

Positive “psoas sign” (pain with hip extension)

IVU: displacement of ureter

CT: psoas abscess in association with renal obstruction from

stone

➣Pelvic lipomatosis

IVU: elevation and elongation of bladder

KUB: radiolucent areas in pelvis

CT: pelvic fat

■Gynecologic disease

➣Pregnancy

Sonography: hydronephrosis, right side most common

➣Benign or malignant tumor

CT: characterizes mass and demonstrates hydronephrosis

➣Pelvic inflammatory disease or abscess

Sonography or CT: abscess and hydroureteronephrosis

➣Endometriosis

IVU, sonography or retrograde pyelogram along with pelvic

examination establish diagnosis

■Gastrointestinal disease: CT establishes diagnosis of tumor or

abscess

■Vascular disease

➣Abdominal aortic or iliac artery aneurysm

KUB: rim of calcification along aorta

IVU: deviation of ureter on IVU

CT: aneurysm

➣Ovarian vein syndrome