Duplex kidney at a glance. what does that mean? the collecting ducts, calyces, . Lectures are presented in both didactic and quiz formats. Abdominal ultrasound showed dilatation of the renal collecting system in the lower pole of the right kidney (Fig. There is dilatation of the upper pole ureter (U) and the lower pole renal pelvis (L), with rounding of calyces. The accompanying malformations and symptoms guide the therapy (vesicoureteral reflux, ureterocele, ectopic ureter, recurrent urinary tract infections or urinary tract obstruction). (4) Our case presented with classic symptoms. Double renal artery is the most common renal morphological ... High-yield, educational radiology lectures utilizing a multimodality imaging approach including MRI, CT, ultrasound, radiography, and nuclear medicine. Here we report a case of obstructive uropathy secondary to uretero-inguinal hernia involving duplicated ureters. Duplex kidney is a developmental condition in which one or both kidneys have two ureter tubes to drain urine, rather than a single tube. Most patients are asymptomatic, with genitourinary tract abnormalities being detected incidentally on imaging studies performed for other reasons. This kidney was more than 5 cm long at 27 weeks' gestation. Duplex kidney also called duplicated renal collecting system, is a developmental condition in which one or both kidneys have two ureter tubes to drain urine into the bladder, rather than a single tube. The reported incidence of ureteral duplication is 1 in 125, or 0.8%. Complete duplication is most often associated with . Duplicated Renal Collecting System "Dilated Ureter" Duplicated Renal Collecting System "Ureterocele(s) in Bladder" Duplicated Renal Collecting System Ultrasound Findings Abuhamad 1996. In the majority of cases there is an association with a duplicated collecting system (80-90%) and ectopic ureter (75%), 10-20% of ureterocoeles are bilateral. Ultrasound (US) may show dilatation of one or both renal pelves, with an intervening band of renal tissue. Feb 8, 2015 - A duplex collecting system, or duplicated collecting system, is one of the most common congenital renal tract abnormalities. The ultrasound can take 30 to 60 minutes to complete. Images to this case: [ X-Ray ] [ Ultrasound ] [ OP-Situs ] [ All ] Duplicated Renal Collecting System with Hydronephrosis of the Upper Pole Moiety due to Ectopic Ureter Dirk Schaper, J Hoff. 2 The ureteric bud is absorbed into the . Duplex Kidney. Conclusions. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Ureterocele Duplex kidney also called duplicated renal collecting system, is a developmental condition in which one or both kidneys have two ureter tubes to drain urine into the bladder, rather than a single tube. A. First trimester fetal kidneys at both sides of the lumbar spine. The above B-mode ultrasound image (left) and Color Doppler image (right) show a cystic lesion involving the collecting system (middle calyx) of the right kidney. A complete bilateral renal duplicated system can have various anatomical variations which lead to varied . Images 11,12: 35 weeks, Images show a coronal view of the left kidney with . 2A-D). Duplication anomalies are one of the most common congenital abnormalities of the urinary tract, occurring in 1% of live births (1). Figure 1: Sagittal grayscale image of the left kidney showing a duplicated collecting system. 13 Curved reformatted image of the contrast-enhanced computed tomography shows the full-length ectopic . Duplicated renal collecting system. Duplex kidneys are a normal variant, meaning that they occur commonly enough in healthy . The lower pole moiety is opacified with contrast material. e. horseshoe kidney. There are only a few reports on laparoscopic pyeloplasty in kidney abnormalities and only one case for laparoscopic pyeloplasty in a duplicated system. Retrograde urethrographic images of ureteroceles in 6-month-old boy with bilateral duplicated collecting systems (not shown). Open in a separate window. Ureterocele. Duplication of the renal collecting system is recognized in approximately 1 : 4000 pregnancies and is more frequent in females. Cystoscopy at eight months of age revealed a single right and left ureteral orifice orthotopically located. An alternative examination is contrast-enhanced voiding urosonography (ceVUS), during which an ultrasound contrast agent is instilled into the urinary bladder and ultrasound is used to assess the urinary tract and grade VUR in a similar fashion to VCUG. • Ureterocele in the bladder is often first clue to diagnosis • Keep in mind that ureteroceles can collapse ineal sonography. Treatments for duplex kidneys Duplex kidneys that are not causing problems do not require treatment. Ultrasound is the modality of choice to evaluate infants and children. Duplex kidney or ureteral duplication is a normal variant and thus not subject to treatment. Perineal sonography is a simple, quick, beneficial, and noninvasive technique that can be used as an extension of abdominal sonogra- Duplex collecting systems can be unilateral or bilateral and can be associated with a variety of congenital genitourinary tract abnormalities. female ratio is 1:3-5. Duplex kidney, also called duplicated collecting system, occurs in about 1 percent of children and usually requires no medical treatment. Ureteral development begins at four weeks in the fetus with the ureteral bud (which determines the entire collecting system) branching from the mesonephric duct. The collecting system could be identified in all kidneys and its wall thickness varied between 0 (not visible) and 0.8 mm. Fig. mri urography, bilateral duplicated collecting system - kidney scan stock . a. ultrasound cannot be used to detect hemorrhage within a renal cyst . Ultrasound Evaluation of . It is well known that splitting of the renal sinus echo complex can be seen both with a bifid system and with a true nonobstructed duplication. Although the clinical presentation can . Image 10 shows a normal looking urinary bladder. Figure 2 . On the left, we can identify the upper moiety (**) separated by renal parenchyma (p) from the lower moiety. The length of the kidney typically exceeds the 95th percentile. UPJ obstruction. A 24-year-old married Arab woman presented with ascending left-sided . In a normal urinary tract, each kidney is connected to one ureter (a tube that drains urine into the bladder). Classic example of Duplex collecting system with Weigert-Me. Images 9,10: Image 9 shows a sagittal view of the right kidney with duplicated collecting system. Duplicated Collecting System • Upper pole drained by . 80-93% are unilateral (1,2), the upper segment is involved in 85% of cases, and ureterocele is present in 24-47% of cases (3-5). Duplicated Collecting System-2 sinuses on US . Most patients are asymptomatic, with genitourinary tract abnormalities being detected incidentally on imaging studies performed for other reasons. The combination of a duplicated collecting system with ectopic implantation is a rare congenital anomaly, in contrast to a duplicated collecting system, which is more common. Traditionally, the diagnosis of duplicated renal collecting system and delineation of ectopic ureter orifices are made with ultrasound, IVP, retrograde pyelography, and cystoscopy. A uretero-inguinal hernia involving duplicated ureters has not been previously described in literature. 11.4 (A,B) Nephrostomy tube placement in duplicated collecting system with upper moiety obstruction. A duplex kidney is characterised by the presence of two separate pelvicalyceal systems with complete or partial duplication of the ureters ( Fig. See this site for image of duplicated collecting system, a common normal variant: . Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Normal ultrasound image of the fetal kidneys and bladder. 62, page 2 of 3 Behaeghe et al: Duplicated Collecting System with Ectopic Vaginal Implantation Diagnostic tools include ultrasound, intravenous urography, voiding cystourethrography, CT and MR imaging. Children with ureteral duplication have an 80% incidence of an associated ureterocele. Art. . Case 2 This is a case of the unilateral double renal artery. Duplicated collecting system or duplex kidney is defined as a division of the renal collecting system into separate upper and lower poles. Ectopic insertion sites of upper moiety ureters as described above. I had ultrasound done and it said a prominent column of berlin versus a duplicated collecting system is seen in the right kidney. Duplex kidneys can occur in one or both kidneys. 1), no visible calculi. It disproportionately affects the left kidney, and is bilateral in 15% to 20% of cases. Duplex kidney, also called duplicated collecting system, occurs in about 1 percent of children and usually requires no medical treatment. The ultrasound image will usually provide the anatomic Increasing experience in laparoscopic techniques allows proper treatment of such anomalies. D, Coronal T2-weighted MR image shows dilatation and tortuosity of bilateral upper pole moiety ureters. Index. (Fig. As you try and measure the length of the right kidney you can't seem to get the lower pole into the image. Abdominal CT revealed a duplicated IVC, a duplicated collecting system of the right kidney, and a prominent dorsal pancreatic duct consistent with pancreatic divisum. Medical tests to diagnose a duplex kidney Duplex kidneys are usually diagnosed with imaging tests, such as ultrasound, CT or MRI scans. Duplicated Collecting System With Ectopic Vaginal Implantation . The duplex collecting system is a common congenital malformation of the genitourinary system with an incidence of about 1-3% (4,5). Figure 1: Sagittal grayscale image of the left kidney showing a duplicated collecting system. As you follow the kidney down to the lower pole you realize that . A reformatted coronal image from a CT urogram demonstrates a partially duplicated collecting system on the left side with two ureters (black and white arrows) that join at the pelvic inlet and insert as one ureter into the bladder. These two ureters can drain independently into the bladder or connect and drain as a single ureter into the bladder. The duplicated renal collecting system can be partial or complete, depending on a partial or full-length separation of the ureters. Images 11,12: 35 weeks, Images show a coronal view of the left kidney with . Thickening of the wall ≥ 1mm is be considered as abnormal. Duplex collecting systems can be unilateral or bilateral and can be associated with a variety of congenital genitourinary tract abnormalities. Abdominal ultrasound revealed a normal appearing liver and spleen, but it showed a duplicated right renal collecting system. Ultrasound image of the same patient (in Picture 2), demonstrating that the left kidney has a duplex collecting system. The image obtained between the separate sinus elements shows normally enhancing renal parenchyma, without the anticipated renal sinus components, such as fat, blood vessels, and collecting . However, if they are asymptomatic, they may not be noticed until adulthood. UPJ obstruction. However, duplex kidney may be associated . Duplicated Renal Collecting System with Hydronephrosis of the Upper Pole Moiety due to Ectopic Ureter. It was diagnosed during the ultrasound examination at 22 weeks of gestation. This occurs due to an incomplete fusion of the upper and lower pole of the kidney which creates two separate drainage systems from the kidney. According to ureteral morphology, duplicated kidneys can be incomplete or complete , unilateral or bilateral. Duplex collecting systems can be unilateral or bilateral and can be associated with a variety of congenital genitourinary tract abnormalities. . d. mirror image artifact e. multipath artifact. Images 7,8: Coronal view of the left kidney, measured is the length of the kidney, note the duplicated renal pelvis. Double/Duplicated ureters: Two ureters that drain separately into the urinary bladder or genital tract (Complete ureteral duplication). vessels, urinary tubes & fibrous material. Duplicated collecting system Excretory phase of conventional IVU shows normal right collecting system and duplicated left collecting system. A Case Presentation and relative topic review regarding ureterocele and duplicated collecting system during my clerkship in Image Diagnostic Department SlideShare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Ureteral diseases. Images 7,8: Coronal view of the left kidney, measured is the length of the kidney, note the duplicated renal pelvis. It is characterized by an incomplete fusion of upper and lower pole moieties resulting in a variety of complete or incomp. Download : Download full-size image; Fig. The kidney on the affected side may have a duplicated pelvicalyceal system or there may be two separate kidneys. (white arrow), in the pelvic cavity in between bladder (B) and rectum (R). Vesicoureteral reflux may be associated. The orange arrow points to the upper pole collecting system and the red arrow points to the lower pole collecting system. Image courtesy of Steven Kraus, MD, Cincinnati, Ohio. Unilateral duplication is more common than bilateral [4]. The following day a CT urography was performed that confirmed the ultrasound findings of the right kidney but also showed bilateral incomplete ureteral duplication. B CT urogram 3D reformatted image shows the asymmetric collecting system appearance.C This coronal MIP image shows the ureterocele in the bladder due to the ectopic insertion of the upper pole ureter . Download : Download full . An alternative examination is contrast-enhanced voiding urosonography (ceVUS), during which an ultrasound contrast agent is instilled into the urinary bladder and ultrasound is used to assess the urinary tract and grade VUR in a similar fashion to VCUG. Unilateral duplication occurs about six times more often than bilateral duplication, with the right and left sides being involved about equally. On ultrasound images, a ureterocele appears as a round cystlike structure within the bladder (Figure 6-12C). Duplex collecting systems are one of the most common congenital anomalies, with an incidence of 0.8%. Image 1: This is a coronal view of the fetal abdomen, Doppler imaging of the aorta branching into iliac arteries, note double renal arteries originating from the abdominal aorta. What is a renal kidney duplex? The reported incidence of ureteral duplication is 1 in 125, or 0.8%. This device transmits sound waves that produce images of blood vessels and the flow of blood through them. Children with a duplex kidney (also called a duplicated collecting system) have two ureters coming from a single kidney. FIGURE 1: Renal ultrasound Prone ultrasound image of the right kidney in the sagittal plane demonstrates a duplicated collecting system. The CT scan was performed with a 64 row MDCT system (Siemens Somatom Definition AS). The accompanying malformations and symptoms guide the therapy (vesicoureteral reflux, ureterocele, ectopic ureter, recurrent urinary tract infections or urinary tract obstruction). The combination of a duplicated collecting system with ectopic implantation is a rare congenital anomaly, in contrast to a duplicated collecting system, which is more common. Ultrasound Obstet Gynecol:7;174. Ultrasound is the imaging of choice in the initial assessment, since it is widely available, low-cost and can It is a common renal anomaly occurring with an incidence of 1 in 125 in the general population. We describe a rare case of bilateral duplex collecting system with bilateral vesicoureteral reflux in which the refluxing ureter on the left side drains the upper pole moiety contrary to what is often found. The duplicated renal collecting system can be partial or complete, depending on a partial or full-length separation of the ureters. a. duplicated collecting system b. supernumerary kidney c. ureterocele d. pelvic kidney e. horseshoe kidney. 13.4. A fetal duplication of collecting systems is generally diagnosed by ultrasound examination before birth. Ureteral diseases. The 3D images revealed important data about the entire collecting system and the ureters, namely a duplicated collecting system on the left side and subsequently both ureters extending from the kidney to the point of extravesical insertion into the vagina. Duplex kidneys can be uni- or bilateral and are more frequent in females. Bilateral duplicated pelvicalyceal systems and ureters with gross hydroureteronephrosis (L>R) of the upper moieties. 5 Curved reformatted image of the… Figure 2 . 45 episodes. The rectum was filled with ultrasound gel. 33.20 ). What Are the Symptoms of Fetal Duplication of Collection Systems? Ultrasonographic study of 48 renal collecting systems in 24 healthy children (age range 3 days to 12.6 years). Duplex kidney is a developmental condition in which one or both kidneys have two ureter tubes to drain urine, rather than a single tube. 11.3.A 21-gauge needle (arrowhead at needle tip) has been passed under real-time ultrasound guidance into the upper pole collecting system (between arrows). However, its feasibility in difficult cases with altered kidney anatomy such as that of duplicated renal pelvis still needs to be addressed. Bifid collecting system: A duplex kidney with the two separate pelvicalyceal collecting system uniting at the pelviureteric junction or as bifid ureters (Incomplete ureteral duplication). A bilateral duplex collecting system is an unusual renal tract abnormality. Browse 292 kidney scan stock photos and images available, or search for kidney scan mri to find more great stock photos and pictures. b. reverberation artifact. Image 1: This is a coronal view of the fetal abdomen, Doppler imaging of the aorta branching into iliac arteries, note double renal arteries originating from the abdominal aorta. Fig. 1. Radiology Lectures | Radiologist Headquarters on Apple Podcasts. Most patients are asymptomatic, with genitourinary. PedRad [serial online] vol 4, no. Bilateral Vesicoureteral reflux with duplicated right collecting system: Oblique image from a retrograde voiding cystourethrogram shows contrast refluxing into the bilateral ureters and kidneys.The right collecting system is duplicated with massive hydroureter of the upper pole moiety ureter. A duplex collecting system is a congenital kidney anomaly with an incidence of 0.8%. Moutos and associates found a double collecting system in one (4.0 %) case among 25 patients with a didelphic uterus [24]. However, duplex kidney may be associated . This suggests a calyceal diverticulum /calyceal cyst of the right kidney. Image on right is showing specimen of upper pole nephrectomy 3. . According to the American Academy of Pediatrics [ 77 ] a duplex kidney is defined as a kidney with 2 pelvic caliceal systems. No dilatation of the distal ureter. The sign is most often seen on axial CT images obtained between the upper- and lower-pole duplicated collecting system elements of the kidney (Fig. Lower pole ureters (not shown) were normal in caliber. Case 2 This is a case of the unilateral double renal artery. The 3D images revealed important data about the entire collecting system and the ureters, namely a duplicated collecting system on the left side and subsequently both ureters extending from the kidney to the point of extravesical insertion into the vagina. Prone ultrasound image of the right kidney in the sagittal plane demonstrates a duplicated collecting system. Duplication of the collecting system is the most common congenital abnormality of the upper urinary tract, with incidence reported to be between 0.8-2% [1-4]. The CT scan was performed with a 64 row MDCT system (Siemens Somatom Definition AS). Most people do not need treatment. Unilateral duplication occurs about six times more often than bilateral duplication, with the right and left sides being involved about equally. These video podcasts are designed for radiology residents . Duplex kidneys can occur in one or both kidneys. Evaluation of the kidneys is part of the routine ultrasound examination done by many obstetricians as part of their prenatal care around the 20th week of pregnancy. Duplex kidney at a glance. Duplex kidney, also known as duplicated ureters or duplicated collecting system, is the most common birth defect related to the urinary tract. A, Axial T2-weighted MR image shows dilatation of upper pole collecting system of duplex system and displacement of lower pole of kidney (arrow). The orange arrow points to the upper pole collecting system and the red arrow points to the lower pole collecting system. Gray-scale ultrasound image of the left kidney showing the duplex system with hydronephrosis and a calculus in the middle calyx (left) and duplication of upper ureters (right, arrows) Discussion Ultrasound can strongly suggest an obstructed duplicated system by identifying the dilated upper pole and dilated ureter leading into it. Index. Duplex kidney, also known as duplicated ureters or duplicated collecting system, is the most common birth defect related to the urinary tract. What does fluid in the system mean after a ultrasound of kidneys? Two-dimensional ultrasonography may be suboptimal in the detection of trivial congenital renal tract malformations as a duplicated system and will be indefinite in distinguishing between partial and complete duplication. Image 10 shows a normal looking urinary bladder. normal lower pole system. A Coronal CT urogram with MIP reformatted image shows the dilated, unopacified upper moiety of the duplicated left collecting system. Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. . The walls of the cystic lesion are thin but irregular and possibly communicate with the renal pelvis. 6—35-year-old man with ectopic insertion of draining ureter from upper pole moiety of duplicated left renal collecting system. Duplex kidney or ureteral duplication is a normal variant and thus not subject to treatment. 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