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1. Periureteral (Hutch) diverticulum

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Figure 48-1

Periureteral (Hutch) diverticulum.

A right anterior oblique image from a cystogram shows a large diverticulum (D) arising from the posterolateral aspect of the bladder. Refluxed contrast opacifies the right ureter, which drapes around the diverticulum. There is an abnormal right-angle orientation of the ureter (arrow) at its insertion into the bladder wall.

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2. Grading system for VUR

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Figure 48-2

Grading system for VUR.

Classification of the vesicoureteral reflux into 5 grades is based on the level of reflux, the severity of collecting system dilation, and caliceal morphology.

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3. Reflux nephropathy

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Figure 48-3

Reflux nephropathy.

An IV urogram shows a small scarred left kidney, with calyceal distortion.

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4. Vesicoureteral reflux

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Figure 48-4

Vesicoureteral reflux.

Posterior images from a radionuclide cystogram demonstrate bilateral VUR. Reflux initially occurs into the left ureter (arrow). There is increased reflux into the right ureter during voiding (arrow).

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5. Reflux nephropathy

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Figure 48-5

Reflux nephropathy.

Posterior and posterior-oblique dimercaptosuccinic acid (DMSA) scintigraphy images show a small, scarred left kidney.

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6. Endoscopic periureteral injection mound

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Figure 48-6

Endoscopic periureteral injection mound.

A longitudinal sonographic image obtained with the transducer angled to the left shows a hyperechoic mound (arrow) projecting into the base of the bladder.

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7. Endoscopic periureteral injection mounds

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Figure 48-7

Endoscopic periureteral injection mounds.

There are prominent echogenic "mounds" (arrows) at the base of the bladder on this transverse image.

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8. Endoscopic periureteral injection mound

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Figure 48-8

Endoscopic periureteral injection mound.

A. An oblique image from a voiding cystourethrogram shows a well-defined filling defect projecting into the posterior aspect of the bladder lumen. B. A transverse sonographic image confirms the presence of an echogenic periureteral mound (arrow).

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