A 21years old man was hospitalized due to left lumbago and the pain was persistent blunt one, radiating to back and abdomen, more serious during night for one month. Physical examination revealed full belly slight tenderness and pain point extending along renal and ureteral regions. Immediate ultrasound showed bilateral upper ureteral dilation and hydronephrosis in local hospital. Laboratory tests showed obvious increased in CA125(270.70KU/L)and slight in creatinine (142.9 umol/ L༉.
Then, ureteroscope examination was performed and showed right posterior wall of bladder rising a mass(4 cm×3 cm×2.5 cm)but vesicle surface is smooth, as well as right inferior ureter was narrow but there was no any calculus and neoplasm, which illustrated a large possibility of compression outsides. CT hereupon proved the result same as the ultrasound, no obvious sign of tumors in the peritoneal cavity in our hospital. Several days later, retrograde pyelography images showed that the right upper ureter dilated like a double tube,lower intensity linear divides spreading along the urinary tract to the middle, entire sign of ureter resembling to radiologic findings of AD, the bigger one locating in the posterior, the little one anterior, and contrast medium leaking into surrounding cavity [Fig. 1]. An hour later, the abdominal CT clearly found the two cavities signs, meanwhile a gap in the low intensity divide and the chasm of right proximal ureter with strip and cast-shaped high intensity filling in the perirenal cavity mixing with low intensity of fluid༈intensity of urine༉. After biopsy through colonoscopy referring to carcinoma of sigmoid and rectum, laparotomy clarified the metastases in abdominal cavity, and entire right ureter and partial left ureter wall thickened with heterogeneous reinforcement implying metastatic tumor invasion is the main culprit [Fig. 2]. After several months, the patient died just 21 years old.
43-year-old female was admitted to urology department with complaint of right waist and abdominal discontinuous colic following with fever for two days. Physical examination found that the tenderness lied in the right renal and ureteral extending district. Laboratory tests showed that slight rise of creatinine. The patient has a history of subtotal hysterectomy three days ago due to uterine leiomyoma and denied history of drugs and family history. CT urography (CTU) were performed in local hospital and indicated that free liquid in the peritoneal cavity, right perirenal region was full of high intensity of contrast medium as well as disappearance of inferior ureteral tract [Fig. 3]. But in our hospital showed that the right upper dilated part has two tubes and they are like double ring in the traverse layer with different intensity, big one lying behind with relative high intensity, little one located in the front like filling-defect during early stage of scanning but reversal in the late period; the low-intensity divide between them along ureteral spreading meanwhile rupture was found at the middle of ureter, and contrast medium was full of adjacent cavity where sudation of strip or tablet symbols peritonitis [Fig. 4]. Instant operation clarified imaging result. Finally, the patient discharged asymptomatically for suitable treatment.