ureteric filling defect from a vena caval clip

BJU International (1999), 83, 351–352

CASE RE PORT

Ureteric filling defect from a vena caval clipC.M. GONZALEZ and W.A. COOKDepartment of Urology, Northwestern University Medical School, Chicago, IL, USA

Rigid ureteroscopy revealed no evidence of uretericCase report

irregularity but there was narrowing of the ureter at thelevel of the filling defect. Cytology, brushings and cultureA 48-year-old woman presented with persistent micro-

scopic haematuria but denied any constitutional symp- were unremarkable for carcinoma, infection or tubercu-losis. CT with (Fig. 3a) and without (Fig. 3b) contrasttoms or flank discomfort. The patient had passed a mixed

calcium and uric acid stone 6 months previously. She was used to confirm an Adams-DeWeese vena caval clipimpinging on the right ureter as the cause of the fillinghad a remote history of recurrent lower extremity deep

venous thrombosis which required a vena caval clip in defect. The patient remains asymptomatic at 6 monthsof follow-up.1973. A physical examination and serum chemistry

were normal; her urinary pH was 5.0 and urine culturewas negative for bacterial growth. IVU revealed a filling

Commentdefect of the right proximal ureter and she was startedon oral alkalinization. Repeat IVU 6 weeks later revealed Before endoluminal filters, transabdominal vena caval

clip placement was used for caval interruption. Thesethe same right ureteric filling defect (Fig. 1). Subsequentcystoscopy was normal with a bilateral retrograde pyelo- Teflon clips are both safe and eCective in preventing

pulmonary embolism in high-risk patients [1]. This isgram confirming the right ureteric filling defect (Fig. 2).

Fig. 2. Right retrograde pyelogram confirming the ureteric fillingFig. 1. IVU showing the right proximal ureteric filling defect. defect.

351© 1999 BJU International

352 CASE REPORT

Fig. 3. CT without (left) and with (right)contrast enhancement showing the venacaval clip impinging on the right ureter.

Authorsthe first case report of a vena caval clip clinicallyimpinging on the right ureter. C.M. Gonzalez, MD.

W.A. Cook, MD.Correspondence: Dr C.M. Gonzalez, 629 W Buckingham Place,

References Unit G, Chicago, IL 60657, USA.1 Rosenthal D, Cossman D, Matsumoto G, Callow AD.

Prophylactic interruption of the inferior vena cava. Aretrospective evaluation. Am J Surg 1979; 137: 389–93

© 1999 BJU International 83, 351–352