A 32-year-old man reports vague right loin discomfort. CT urogram reveals right hydronephrosis with a normally opacified ureter that curves medially at the level of L3, passing behind the inferior vena cava before emerging and continuing to the bladder. Renal function is preserved. What is the diagnosis?

• A Horseshoe kidney
• B Retrocaval ureter ✓
• C Ureteric duplication with obstructed lower moiety
• D Pelvic kidney

Explanation

B retrocaval (circumcaval) ureter results from persistence of the posterior cardinal vein, so the right ureter passes behind the IVC, typically at L3, producing a medial deviation and fish hook appearance with proximal dilatation. Horseshoe kidney would show fusion across the midline with anteriorly displaced ureters, a pelvic kidney sits in the pelvis, and duplication shows two separate ureters on one side. Symptomatic cases are treated by division and ureteroureterostomy anterior to the cava.

Reference: Campbell-Walsh Urology, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.