Ureteropelvic Junction (UPJ) Obstruction

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✅Ureteropelvic junction (UPJ) Obstruction

Pelviureteric junction (PUJ) obstruction/stenosis, also known as ureteropelvic junction (UPJ) obstruction/stenosis, can be one of the causes of obstructive uropathy. It can be congenital or acquired with a congenital PUJ obstruction being one of the commonest causes of antenatal hydronephrosis.

PUJ obstruction is most commonly unilateral but is reported to be bilateral in ~30% (range 10-49%) of cases 10. There is a recognized predilection towards the left side (~67% of cases).

During embryogenesis, the pelviureteric junction forms usually around the fifth week and the initial tubular lumen of the ureteric bud become recanalized by ~10-12 weeks. The PUJ area is the last to recanalize. Inadequate canalization is thought to be the main embryological explanation of a PUJ obstruction. Extrinsic obstructions secondary to bands, kinks, and aberrant vessels also are commonly encountered.

Ultrasound findings:

- Will often show a dilated renal pelvis with a collapsed proximal ureter.

- Doppler sonography: the obstructed kidneys may show higher resistive indices.

Associations:

- In congenital cases, some renal tract abnormalities are recognized.
- Renal duplication
- Multicystic dysplastic kidneys
- Horseshoe kidney or cross fused ectopia

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