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Age: 9

Sex: Female

Indication: Pyelonephritis

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Case #31


Findings

  • Moderate right hydronephrosis
  • No left hydronephrosis
  • Asymmetrically small left kidney with atrophic appearance of the upper pole
  • Spleen is enlarged, measuring up to 13.6 cm
  • Bilateral calcified bulking material at the ureterovesicular junctions related to prior treatment of vesicoureteral reflux


Diagnosis

Deflux mounds

Sample Report

Moderate right hydronephrosis. No left hydronephrosis. No obstructing ureteral calculi identified, though CT could provide further assessment if there is ongoing concern.

Asymmetrically small left kidney with atrophic appearance of the upper pole.

Splenomegaly.

Incidental note is made of bilateral calcified bulking material at the ureterovesicular junctions related to prior treatment of vesicoureteral reflux.


Discussion

  • Many agents exist for endoscopic treatment of vesicoureteral reflux
  • Deflux (Oceana Therapeutics) is what was used in this particular case
  • While these agents have a variable imaging appearance, they generally result in a symmetric masslike appearance at the ureterovesicular junctions, which can be mistaken for calculi


Images

Bilateral deflux mounds resulting in a bulging contour of the bladder wall at the ureterovesicular junctions (red arrows). These demonstrate areas of calcification with posterior acoustic shadowing, which can be confused for ureteral calculi.

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