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Fig. 2. Duplex kidney with obstructed ectopic upper-pole ureter. The ureter is inserted into the urethra. Newborn female. a, b Longitudinal scans of the left kidney reveal a dilated upper-pole collecting system. c Transverse pelvic scan and d transperineal sagittal scan show the upper-pole ureter (U) behind the bladder (B) and before insertion (arrow) into the urethra (xxx). V = vagina; S, pubic symphysis. e Transperineal sagittal color flow Doppler image shows retrograde ureteral jet from the urethra into the bladder. f 2-year-old girl. Cyclic voiding cystourethrogram shows pinpoint opening of the ectopic ureter. (Reprinted with permission from [2])

in the posterior urethra with a pinhole opening positioned posteriorly near the verumontanum. During voiding, the anterior portion of the membrane bulges. This urethral obstruction causes high intraluminal pressure during the early phases of foetal development, leading to abnormal bladder function and anatomy (trabeculation, bladder neck hypertophy), renal dysplasia, hydronephrosis, and vesicoureteral reflux. Vesicoureteral reflux often persists after relief of the obstruction. Prenatal and postnatal ultrasound document bilateral hydroureteronephrosis associated with parenchymal dysplasia and a thick-walled bladder. In cases of severe hydronephrosis, rupture of the intrarenal collecting system at the calyceal fornix leads to perirenal urinoma and urine ascites.

Anomalies of Renal Vessels (Fig. 3)

Each kidney is normally supplied by a single renal artery, although one or more accessory renal arteries are not uncommon. The renal artery originates from the abdominal aorta and runs behind the vena cava to reach the hilar region of the kidney.

In patients with interruption of the inferior vena cava with azygos continuation, the azygos vein increases in size and might be mistaken for the inferior vena cava. Cross-sectional imaging techniques document the course of the renal artery to be ventral to the azygos vein. Azygos continuation is frequently associated with cardiac and situs anomalies and awareness of the anatomic rela

tionship between the renal artery and the azygos vein can aid in diagnosis [3].

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