Lahoud Rita Maria, Esker William D, Thurston Shirley A, Kohanski Michelle, Elder Jack S, Lim Ruth
Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Division of Pediatric Urology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Radiol Case Rep. 2020 Dec 23;16(3):555-559. doi: 10.1016/j.radcr.2020.12.048. eCollection 2021 Mar.
Intermittent ureteropelvic junction obstruction, or Dietl crisis, is a rare entity with sparse reports in published literature. Establishing the diagnosis is challenging given its intermittent nature. We report a case of Dietl crisis, focusing on ultrasound (US) and magnetic resonance urography (MRU) findings in a 7-year-old boy with recurrent episodes of colicky abdominal pain prompting multiple visits to the emergency department. Severe left hydronephrosis was visualized on US during one episode with complete resolution on follow-up US. MRU demonstrated severe left hydronephrosis with delayed calyceal transit time, time-to-peak enhancement, and excretion. There was no aberrant blood vessel. Surgical pyeloplasty provided complete symptomatic resolution. MRU can be a valuable tool in eliciting and dynamically confirming the diagnosis of Dietl crisis.
间歇性肾盂输尿管连接部梗阻,即Dietl危象,是一种罕见病症,在已发表的文献中报道较少。鉴于其间歇性特点,确立诊断具有挑战性。我们报告一例Dietl危象病例,重点关注一名7岁男孩的超声(US)和磁共振尿路造影(MRU)检查结果,该男孩反复出现绞痛性腹痛,多次前往急诊科就诊。在一次发作期间,超声显示左侧重度肾积水,后续超声检查显示积水完全消退。MRU显示左侧重度肾积水,伴有肾盏延迟转运时间、达峰强化时间及排泄延迟。未见异常血管。手术肾盂成形术使症状完全缓解。MRU在引发并动态确诊Dietl危象方面可能是一种有价值的工具。