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UROLOGICAL IMAGES |
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| Year : 2015 | Volume
: 31
| Issue : 4 | Page : 372-373 |
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Left retrocaval ureter without situs inversus or inferior venacava duplication
Vasudevan Thirugnanasambandam, Prasant Nayak, Abdulrazack Mossadeq
Department of Urology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry, India
| Date of Web Publication | 1-Oct-2015 |
Correspondence Address:
Vasudevan Thirugnanasambandam
Department of Urology, Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, Puducherry - 607 402
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-1591.166481
 Abstract | | |
Retrocaval ureter (pre-ureteral vena cava) is an uncommon congenital anomaly that causes ureteral obstruction by external compression. Although right retrocaval ureter is a common entity, left retrocaval ureter is extremely rare. A left retrocaval ureter is usually associated with situs inversus or duplicated inferior venacava (IVC). An isolated left retrocaval ureter with single left-sided IVC is even rarer and only four cases have been reported in the literature. We present images of a case with isolated left retrocaval ureter with a single left-sided IVC without situs inversus.
Keywords: Left venacava, pre-ureteral venacava, retrocaval ureter
How to cite this article:
Thirugnanasambandam V, Nayak P, Mossadeq A. Left retrocaval ureter without situs inversus or inferior venacava duplication. Indian J Urol 2015;31:372-3 |
| Introduction | |  |
A retrocaval ureter or pre-ureteric venacava is a rare anomaly which occurs in 1 per 1000 live births. This is caused by an abnormal development of Inferior Venacava (IVC). It is seen three times more often in males and is usually on the right side. A left retrocaval ureter as such is very rare and is usually associated with situs inversus or IVC duplication [1],[2],[3],[4],[5]. Isolated left retrocaval ureter without any situs or IVC duplication is very rare. These patients usually present in the third or fourth decades and symptoms depend on the degree of obstruction.
| Case Report | | |
An 84-year-old male patient presented to us with dull, aching left flank pain of 6 months duration. He was moderately built, well-nourished and ambulant with no physical abnormalities. Ultrasonogram of the abdomen revelaed left hydroureteronephrosis. X-ray of kidney, ureter, and bladder was non-contributory. CT scan of the abdomen revealed transposed IVC to the left side and classic retrocaval ureter with proximal hydro-ureteronephrosis [Figure 1], [Figure 2] and [Figure 3]. All other viscera were orthotopically placed. Chest X-ray showed normally placed cardiac shadow. | Figure 2: Coronal CT image showing left retrocaval ureter with pre-caval (arrowhead) and post-caval (arrow) segments
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 | Figure 3: Axial CT images with arrows showing (a) Pre-caval Ureter (b) Post-caval ureter and (c) Left renal vein
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| Discussion | | |
The embryogenesis of the IVC is a complex process of development involving the posterior cardinal, the subcardinal, and the supracardinal venous systems. Aberrant complexation of these veins can result into four anomalies: Duplicated IVC, transposition of IVC to left, retroaortic left renal vein, and circum-aortic left renal vein. Left retrocaval ureter is rare, and only eight cases have been reported in the literature so far.[1],[2],[3],[4],[5],[6],[7],[8] Left retrocaval ureter without situs and without IVC duplication is rarer with only four cases being reported in the literature.[2],[4],[6],[7] Pierro et al. reported a 0.2 to 0.5% prevalence of transposition of IVC to the left and a 0.1% prevalence of left retrocaval ureter. The management involves ureteroureterostomy, keeping in mind the altered retroperitoneal anatomy while operating.
Financial support and sponsorship
Nil
Conflicts of interest
None declared.
| References | | |
| 1. | Brooks RE, Jr. Left retrocaval ureter associated with situs inversus. J Urol 1962;88:484-7.  |
| 2. | Pierro JA, Soleimanpour M, Bory JL. Left retrocaval ureter associated with left inferior vena cava. AJR Am J Roentgenol 1990;166:545-6. |
| 3. | Watanabe M, Kawamura S, Nakada T, Ishii N, Hirano K, Numasawa K, et al. Left preureteral venacava (retrocaval or circumcaval ureter) associated with partial situs inversus. J Urol 1991;145:1047-8. |
| 4. | Ishitoya S, Arai Y, Waki K, Okubo K, Suzuki Y. Left retrocaval ureter associated with the Goldenhar syndrome (branchial arch syndrome). J Urol 1997;158:572-3. |
| 5. | Rubinstein I, Cavalcanti AG, Canalini AF, Freitas MA, Accioly PM. Left retrocaval ureter associated with inferior vena caval duplication. J Urol 1999;162:1373-4. |
| 6. | Gramegna V, Madaro A, Pellegrini F, Capizzi S, Romano O, Massari D, et al. A rare case of retrocaval ureter associated with persistent left vena cava. Urol Int 2003;70:337-8. |
| 7. | Kozyrakis D, Prombonas I, Kyrikos V, Grigorakis A, Pliotas G, Malovrouvas D. Left Retrocaval Ureter Associated With Urothelial Malignancy. Urol J 2012;9:527-9. |
| 8. | Kim AY, Park BK, Kim CK, Park SY, Han DH . Case Report of Left Retrocaval Ureter: Pre-Transplant CT Urographic Findings and Post-Transplant Outcomes. J Korean Soc Radiol 2013;68:137-40. |
[Figure 1], [Figure 2], [Figure 3]
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