Summaria Vincenzo, Minordi Laura Maria, Canadè Adolfo, Speca Stefania
Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Roma, Italy.
Rays. 2002 Apr-Jun;27(2):89-91.
Primary megaureter is visualized as a typical dilatation on urography. Adequate oblique projections should be added to depict the juxtavesical tract of normal caliber. In even the most severe forms pyelocaliectasis is absent or mild and the ureter is not tortuous. Sonography as well as fluoroscopy during urography shows hyperperistalsis in the dilated tract and aperistalsis in the juxtavesical tract. Cystography rules out vesicoureteral reflux. In prune-belly syndrome the megaureter is bilateral and massive with no evidence of obstructions. The sonographic finding of hydronephrosis or hydroureteronephrosis and the absence of vesicoureteral reflux on voiding cystography lead to the suspicion of ureteral valves, directly documented on urography as sharp and transverse filling defects. Retrograde pyelography can better define the obstructing area and documents the normality of the underlying tract. With this procedure, the valvular flaps appear with a superior convexity (like a small umbrella). MR-urography still to be validated clinically, will be able to provide novel perspectives.
原发性巨输尿管在尿路造影中表现为典型的扩张。应增加适当的斜位投照以显示正常管径的膀胱旁段。即使在最严重的形式中，肾盂扩张也不存在或很轻微，输尿管也不迂曲。超声检查以及尿路造影时的荧光透视显示扩张段有蠕动增强，膀胱旁段无蠕动。膀胱造影可排除膀胱输尿管反流。在梅干腹综合征中，巨输尿管是双侧的且巨大，无梗阻证据。肾积水或肾盂输尿管积水的超声表现以及排尿性膀胱造影时无膀胱输尿管反流提示输尿管瓣膜可疑，在尿路造影中直接表现为尖锐的横向充盈缺损。逆行肾盂造影可以更好地界定梗阻区域并证明下方管道的正常情况。通过此检查，瓣膜瓣叶呈向上的凸面（像一把小伞）。磁共振尿路造影仍有待临床验证，将能够提供新的视角。
