Share J C, Lebowitz R L
Department of Radiology, Children's Hospital, Boston, MA 02115.
AJR Am J Roentgenol. 1990 Sep;155(3):561-4. doi: 10.2214/ajr.155.3.2117358.
Five children (three girls and two boys) who had a duplex collecting system with an ectopic ureter or a ureterocele that was not detected with either imaging or cystoscopy were seen during a 10-year period. Four had urinary tract infection. The fifth was noted to have hydronephrosis when CT scanning of the abdomen was done for trauma. In each case, voiding cystourethrography showed reflux into what was thought to be a single (nonduplex) collecting system, but was found during surgery to be the lower pole of a duplex system. Excretory urography in four patients, sonography in two, and CT scanning in one did not show signs of duplication on the affected side. In each case cystoscopy failed to show a duplex system on the affected side. The diagnosis of duplication of the collecting system with ectopic ureter or ureterocele was made in each case only when the bladder was opened to reimplant the ureter. Direct opacification of the previously unsuspected upper pole ureter in each case showed it to be bind-ending and terminating at the level of the kidney. Radiologists and surgeons should be aware that duplex systems may not always be visible on urography and sonography.
在10年期间，我们见到了5例（3名女孩和2名男孩）患有重复集合系统且伴有异位输尿管或输尿管囊肿的患儿，这些病变在影像学检查或膀胱镜检查中均未被发现。其中4例有尿路感染。第5例在因外伤行腹部CT扫描时发现有肾积水。在每一例中，排尿性膀胱尿道造影显示尿液反流至被认为是单一（非重复）集合系统的结构，但手术中发现其为重复系统的下极。4例患者的排泄性尿路造影、2例患者的超声检查以及1例患者的CT扫描均未显示患侧有重复的迹象。在每一例中，膀胱镜检查均未发现患侧有重复系统。仅在打开膀胱重新植入输尿管时，才在每一例中诊断出伴有异位输尿管或输尿管囊肿的重复集合系统。在每一例中，先前未被怀疑的上极输尿管直接造影显示其为盲端且终止于肾脏水平。放射科医生和外科医生应意识到，重复系统在尿路造影和超声检查中可能并不总是可见的。
