Meshaka Riwa, Biassoni Lorenzo, Leung Gorsey, Mushtaq Imran, Hiorns Melanie P
Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, WC1H 3JH, UK.
Department of Clinical Radiology, The Royal London Hospital, Barts Health NHS Trust, London, UK.
Pediatr Radiol. 2023 Mar;53(3):544-557. doi: 10.1007/s00247-022-05557-7. Epub 2022 Dec 20.
Pelviureteric junction obstruction, also known as ureteropelvic junction obstruction, is a congenital narrowing of the urinary excretory tract at the junction between the renal pelvis and the ureter and is a common cause of congenital pelvicalyceal dilatation. The outcome is variable, from spontaneous resolution to renal parenchymal function loss in cases of untreated high-grade obstruction. Abnormalities in renal ascent, rotation and vascularity can be associated with pelviureteric junction obstruction and easily overlooked radiologically. In this pictorial review, we explore the anatomical, radiological and surgical correlations of pelviureteric junction obstruction in the context of a normal kidney and a spectrum of renal abnormalities, including hyper-rotation (also known as renal malrotation), failed renal ascent, fusion anomalies and accessory crossing renal vessels. For each scenario, we provide technical tips on how to identify the altered anatomy at the first ultrasound assessment and correlation with scintigraphic, cross-sectional and postoperative imaging where appropriate. A detailed ultrasound protocol specifically to assess and characterise pelviureteric junction obstruction in paediatric patients is also offered.
肾盂输尿管连接部梗阻，也称为输尿管肾盂连接部梗阻，是肾盂与输尿管连接处尿路的先天性狭窄，是先天性肾盂肾盏扩张的常见原因。其结果各不相同，从自行缓解到未经治疗的重度梗阻病例中的肾实质功能丧失。肾脏上升、旋转和血管异常可能与肾盂输尿管连接部梗阻相关，且在放射学检查中容易被忽视。在本图像综述中，我们探讨了在正常肾脏以及一系列肾脏异常情况下，包括过度旋转（也称为肾脏旋转异常）、肾脏上升受阻、融合异常和交叉异位肾血管等情况下，肾盂输尿管连接部梗阻的解剖学、放射学和手术相关性。对于每种情况，我们提供了关于如何在首次超声评估时识别解剖结构改变以及在适当情况下与闪烁扫描、横断面成像和术后成像进行关联的技术提示。还提供了专门用于评估和表征儿科患者肾盂输尿管连接部梗阻的详细超声检查方案。
