J Korean Soc Radiol JKSR Journal of the Korean Society of Radiology 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2016.75.4.327 Uroradiology Case Report Periureteral Varices with Accompanying Pyelitis Diagnosed by 3-Dimensional Reformatted Technique of the Multidetector Row CT: A Case Report Yi Ji Hyun MD Department of Diagnostic Radiology, College of Medicine, Yeungnam University, Daegu, Korea. Corresponding author: Ji Hyun Yi, MD. Department of Diagnostic Radiology, College of Medicine, Yeungnam University, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel. 82-53-620-3046, Fax. 82-53-653-5484, ji1354@naver.com 10 2016 29 09 2016 75 4 327 331 13 11 2015 01 02 2016 05 03 2016 Copyright © 2016 The Korean Society of Radiology 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Periureteral varices are rare, and periureteral varices with accompanying pyelitis have been even more rarely reported. Our patient with flank pain was diagnosed with pyelitis because her CT scan showed thickening and enhancement of the ipsilateral renal pelvic wall and her clinical manifestations and laboratory results were well correlated with the diagnosis. Moreover, the author diagnosed periureteral varices because periureteral, tortuous, enhancing vascular structures were detected and 3-dimensional rendering technique of the CT scan showed that periureteral varices were connected to the ipsilateral renal vein. We experienced a case of periureteral varices with accompanying pyelitis, which was definitely confirmed by using the 3-dimensional rendering technique of the CT scan. Therefore, we report the case along with a brief review of the literatures regarding periureteral varices.

 Varicose Vein Ureter Pyelitis Multidetector Computed Tomography Imaging, Three-Dimensional Heal MR Ureteral varicosities--a cause of the corkscrew ureter Br J Surg 1970 57 274 276 Weiner SN Bernstein RG Morehouse H Golden RA Hematuria secondary to left peripelvic and gonadal vein varices Urology 1983 22 81 84 Wendel RG Crawford ED Hehman KN The "nutcracker" phenomenon: an unusual cause for renal varicosities with hematuria J Urol 1980 123 761 763 Kim HS Park JW Won IS Shin KC Kim S Yang J A case of periureteral varices with nutcracker syndrome diagnosed by intravenous pyelography Korean J Nephrol 2009 28 142 145 Trambert JJ Rabin AM Weiss KL Tein AB Pericaliceal varices due to the nutcracker phenomenon AJR Am J Roentgenol 1990 154 305 306 Ali Khan S Jayachandran S Desai PG Bonheim P Renal colic, a presenting symptom of pelviureteric varices Int Urol Nephrol 1985 17 11 14 Martelli A Vitullo F Microscopic hematuria due to peri-ureteral varices Urol Int 1970 25 457 465 Johnson PT Halpern EJ Kuszyk BS Heath DG Wechsler RJ Nazarian LN Renal artery stenosis: CT angiography--comparison of real-time volume-rendering and maximum intensity projection algorithms Radiology 1999 211 337 343 Cuéllar i Calàbria H Quiroga Gómez S Sebastià Cerqueda C Boyé de la Presa R Miranda A Alvarez-Castells A Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance Eur Radiol 2005 15 1745 1751 Periureteral varices in a 70-year-old woman.

A, B. Corticomedullary phase sagittal CT scan (A) and multiplanar curved reformatted image (B) reveal tortuous, tubular venous structures (arrows) along the left ureter. Mild thickening with enhancement of the left renal pelvic wall suggesting pyelitis is noted (red arrows).

C. Maximum intensity projection image shows periureteral varices connected to the Lt. renal vein (arrows).

D. Volume rendering image demonstrates periureteral varices (arrows).