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2017-02-26  Case of the week # 440  ©

Answer to the case of the week # 440
March 2, 2017 - March 16, 2017.
Olga Ivanitskaya, MD, Natalia Odegova, MD

Moscow Regional Research Institute of Obstetrics and Gynecology, Medical-Genetics Department, Moscow, Russia.

Case report 

A 33-year old woman (G5P2), with non-contributive history, was referred to our department after routine 3rd trimester scan due to “renal cyst and intestinal dilatation” of the fetus. Two patients’ children from the previous partner were healthy. The first scan at 12 weeks was normal with low risk of chromosomal abnormalities. 20-week scan also was normal.

Our ultrasound examination at 32 weeks revealed the following findings:

  •  left kidney had normal size and structure. There was mild pyelectasia with  significant dilatation of the left ureter up to 17 mm (image 1);
  • right kidney was 30 x 18 x 20 mm (a little less below 5 centile) without corticomedullary differentiation. Its parenchyma was hyperechogenic with lot of anechogenic cysts up to 8 mm in diameter. Right ureter also was dilated up to 12 mm (images 2 and 3).
  • urinary bladder was enlarged (65*14*20 mm), atonic, with thick hypertrophied wall (4,5 mm). During the whole examination it didn’t emptying or filling (images 4 and 5). 
  • penis was increased in size (32 mm) with dilated urethra with hypoechogenic lumen (images 6 and 7).
Fetal biometry parameters of the baby corresponded to 32 weeks, doppler parameters, placenta and amount of the amniotic fluid were normal.

Our diagnosis was double-sided megaureter, cystic dysplasia of the right kidney, megacystic, megalourethra. At 37-38 weeks a male baby (2470g / 45cm) was born and our findings were confirmed. At the age of three weeks ureteral stenting was performed due to megaureters. Now the boy is under observation of pediatric urologist. 

Image 1: 
Left kidney with dilated left ureter up to 12 mm.

Images 2 and 3: 
Both kidneys with mild pyelectasia and multicystic dysplasia of the right kidney. 
The bladder was between two dilated ureters.


Images 4 and 5: 
Dilated bladder with hypertrophied thick wall.

Images 6 and 7: 
Dilated urethra and kryptochism.

Videos 1-3: showing the double-sided megaureter, cystic dysplasia of the right kidney, megacystic and megalourethra.



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