PMC2878428_01
Noncontrast-enhanced computed tomography scan; (a) Saggital images showing malrotated and cranially displaced right kidney with ureter and retroperitoneal fat herniating into thorax; (b) Coronal images showing right ureter looping into thorax and back into retroperitoneum through a diaphragmatic defect
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In view of her altered renal functions, a noncontrast computed tomography scan was done which revealed a relatively small right kidney that was displaced cranially towards the diaphragm; the renal axis was abnormal with the pelvis facing posterosuperiorly [Figure 1a]. Along with retroperitoneal fat, the dilated right ureter could be seen herniating into the ipsilateral thoracic cavity through a 2.6 cm wide defect in the posteromedial aspect of the right hemidiaphragm [Figure 1b], which was suggestive of a Bochdalek hernia. The lower chest sections showed the ascending and descending limbs of the herniated ureter in a loop configuration [Figure 1b].
Retrograde ureteropyelogram image showing contrast ascending the right upper ureter in the thoracic cavity and then looping down into the pelvicalyceal system
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A subsequent retrograde pyelogram confirmed the classical ureteral loop or knuckle, which has been described as the curlicue sign [Figure 2].