PMC7396064_01
Dissected path of left ureter from the kidney to the iliac arteries. (A) The beginning of the renal pelvis (diameter: 3.15 cm), (B) the end of the renal pelvis (diameter: 0.88 cm), (C) passing over psoas minor (diameter: 1.70 cm), (D) passing under ovarian artery/vein, (E) passing under external iliac artery (diameter: 1.65 cm), and (F) emerging medial to external iliac artery (diameter: 0.45 cm).
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During routine dissection, a markedly dilated left ureter was noticed and further explored (Figure 1).
Terminal branches of the abdominal aorta and paths of ureters. (A) Abdominal aorta, (B) right common iliac artery, (C) left external iliac artery, (D) right ureter passes over common iliac artery, (E) let internal iliac artery, (F) median sacral artery branches off the right common iliac artery, and (G) the left ureter passes between the left internal iliac artery and external iliac artery.
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As a result, the median sacral artery was shifted and was observed branching off the right CIA (Figure 2). After passing beneath the left EIA, the left ureter returned to a normal size (0.45 cm) and position following a normal path to the bladder (Figure 3).
Ureter passes beneath the left external iliac artery and emerges distally with a normal diameter. (A) Proximal, preobstruction end of ureter, (B) the point of obstruction under the left external iliac artery, and (C) distal, postobstruction end of the ureter.
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As a result, the median sacral artery was shifted and was observed branching off the right CIA (Figure 2). After passing beneath the left EIA, the left ureter returned to a normal size (0.45 cm) and position following a normal path to the bladder (Figure 3).
(a) A posterior view of the affected (left) kidney showing three major calyces (asterisks) joining outside of the kidney and a dilated renal pelvis (plus sign). (b) A view inside the affected (left) kidney showing normal-sized minor calyces and pyramids without evidence of hydronephrosis. (c) Also notable was a slight, yet still noticeable, stenosis of the ureteropelvic junction: (i) pre-ureteropelvic junction (diameter: 0.88 cm), (ii) ureteropelvic junction (diameter: 0.50 cm), (iii) post-ureteropelvic junction (diameter 0.75 cm).
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The three major calyces of the left kidney were found to join together outside of the kidney (Figure 4(a)). All arteries and veins of the left kidney were normal, and no evidence of hydronephrosis was observed (Figure 4(b)). Constriction of the ureteropelvic junction (UPJ) was noted, though this slight constriction did not result in any gross renal pathology (Figure 4(c)).