A Diagnostic Pitfall in a Patient with Acute Abdominal Pain: Congenital Hydronephrosis/Hydroureter Misdiagnosed as Hydrosalpinx

DOI: 10.4236/oalib.1100701   PDF        2,180 Downloads   2,682 Views   Citations

Abstract

Clinical manifestation or incidental finding of congenital kidney anomalies are more often discovered during pregnancy. Even if the acute presentation (in the antenatal period, as in this case) precludes a full diagnostic workup, assiduous follow-up and investigations in the postnatal period will resolve the initial uncertainty. This is not a new phenomenon based on literature and urologic differential diagnoses such as an ectopic urinary system which should always be entertained and excluded prior to making the diagnosis of an adnexal mass. We present a case of 33-year-old woman with acute abdominal pain and a previous obstetric (mis)diagnosis of hydrosalpinx (based on ultrasonography) made 8 years before presenting to the emergency department with acute lower abdominal pain, fever, chills and rigors. Current investigations revealed congenital abnormal kidneys bilaterally, with ectopic left kidney and grossly infected hydronephrosis, which was likely the fluid-filled mass initially mistaken for a hydrosalpinx. She then underwent left nephrostomy and later had simple left nephrectomy. This case highlights the importance of making an accurate diagnosis and arranging careful follow-up of the female patient presenting with a “cystic” mass of the pelvic region during pregnancy.

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Balakrishnan, T. and Narayana, D. (2014) A Diagnostic Pitfall in a Patient with Acute Abdominal Pain: Congenital Hydronephrosis/Hydroureter Misdiagnosed as Hydrosalpinx. Open Access Library Journal, 1, 1-5. doi: 10.4236/oalib.1100701.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Hernandez-Rey, A.E., Vitensen, J. and McGovern, P.G. (2007) Duplicated Ectopic Hydroureter Presenting as Hydrosalpinx, with Chronic Pelvic Pain and Recurrent Urinary Tract Infections. Fertility and Sterility, 88, 1677e1-e3.
[2] Bergqvist, A. (1965) Ectopic Kidney as Complication of Pregnancy and Labor. Acta Obstetrica et Gynecologi ca Scandinavica, 44, 289-303.
http://dx.doi.org/10.3109/00016346509155866
[3] Neena M. (2001) Ectopic Hydronephrotic Kidney Masquerading as an Ovarian Cyst during Pregnancy. European Journal of Obstetris & Gynecology and Reproductive Biology, 97, 239-240.
http://dx.doi.org/10.1016/S0301-2115(00)00516-9
[4] Rascher, W. and Rosch, W.H. (2005) Congenital Abnormalities of the Urinary Tract. Oxford Textbook of Clinical Nephrology. Oxford University Press, Inc., Oxford, 1402-1412.
[5] Kemper, M.J. and Muller-Wiefel, D.E. (2001) Renal Function in Congenital Anomalies of the Kidney and Urinary Tract. Current Opinion in Urology, 11, 571-575.
http://dx.doi.org/10.1097/00042307-200111000-00003
[6] Campbell, M.F., Wein, A.J. and Kavoussi, L.R. (2007) Campbell-Walsh Urology. 9th Edition, Saunders Elsevier, Philadelphia, 3279.
[7] Kang, I.J., Lee, S.H., Lee, S.M., Lim, C.H., Yoon, J.H., Kim, T.W., Seo, S.M., Kim, B.S. and Chang, Y.S. (2005) A Case of Congenital Single Ectopic Kidney in Pelvis of Patients with Proteinuria. Korean Journal of Nephrology, 24, 137-140.
[8] Hertzberg, B.S., Kliewer, M.A., Leder, R.A. and Carroll, B.A. (1997) Primary Megaureter Mimicking Hydrosalphinx on Ultrasonography. Journal of Ultrasound in Medicine, 16, 441-444.
[9] Kim, J.M., Hong, J.S., Yoon, J.B., Cho, J.H. and Joo, K.H. (2003) Marked Hydroureter Misdiagnosed as Hydrosapinx by Ultrasound. Journal of the American Association of Gynecologic Laparoscopists, 10.
http://dx.doi.org/10.1016/S1074-3804(05)60141-7
[10] Zalel, Y., Soriano, D., Lipitz, S., Mashiach, S. and Achiron, R. (2000) Contribution of Color Doppler Flow to the Ultrasonographic Diagnosis of Tubal Abnormalities. Journal of Ultrasound in Medicine, 19, 645-649.
[11] Pepe, F. and Color, P.P. (2013) Doppler Ultrasound (CDU) in the Diagnosis of Obstructive Hydronephrosis in Pregnant Women. Archives of Gynecology and Obstetrics, 288, 489-493.
http://dx.doi.org/10.1007/s00404-013-2768-1
[12] Fiadjoe, P., Kannan, K. and Rane, A. (2010) Maternal Urological Problems in Pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 152, 13-17.
http://dx.doi.org/10.1016/j.ejogrb.2010.04.013
[13] Patel, M.D., Acord, D.L. and Young, S.W. (2006) Likelihood Ratio of Sonographic Findings in Discriminating Hydrosalpinx from Other Adnexal Masses. American Journal of Roentgenology, 86, 1033-1038.
http://dx.doi.org/10.2214/AJR.05.0091
[14] Masselli, G., Brunelli, R., Casciani, E., Polettini, E., Bertini, L., Laghi, F., Anceschi, M. and Gualdi, G. (2011) Acute Abdominal and Pelvic Pain in Pregnancy: MR Imaging as a Valuable Adjunct to Ultrasound? Abdominal Imaging, 36, 596-603.
http://dx.doi.org/10.1007/s00261-010-9654-0
[15] Kim, M.Y., Rha, S.E., Oh, S.N., Jung, S.E., Lee, Y.J., Kim, Y.S., Byun, J.Y., Lee, A. and Kim, M.R. (2009) MR Imaging Findings of Hydrosalpinx: A Comprehensive Review. Radiographics, 29, 495-507.

  
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