Spot the diagnosis

24 years old male patient presented with severe pain in left flank since last 2 days. 

No past history of similar pain. 
No vomiting,  no fever. 
Lab reports normal,  no UTI. 
His usg was done,  based on usg findings general surgeon advised CT IVP. 
Posting few images of CT. 
Please spot the diagnosis... 

Spot the diagnosis Spot the diagnosis Spot the diagnosis


  • Gaurang j Vaghela
    Gaurang j Vaghela
    17 Feb 2020 09:59:09 AM

    Puj obstruction due to Crossing vessel 

  • Tanuj Paul Bhatia
    Tanuj Paul Bhatia
    18 Feb 2020 10:51:03 AM

    Agree with Dr Gaurang, Left PUJO with crossing vessel

  • Dr. Anil Takvani
    Dr. Anil Takvani
    18 Feb 2020 04:07:42 PM

    I am providing link of very interesting article related to extrinsic cause of UPJO,anteriorly crossing vessels.

    1. Antenatal detection of HN is negative predictive factor for CRV.
    2. Late pediatric age and adolescence or adult detection of HN following pain or UTI is a positive predictive factor for CRV.
    In last two weeks I came across three patients. One age 24 years and two patients above 40 years. All 3 patients presented with flank pain, two patients additionally had UTI.
    We have to consider in these age group of patients with UPJ-O like USGs for additional investigation like CECT or fMRU. Advantage with fMRU is it gives both functional and anatomical details(like CRV).
    Or else we have to approach all these pyeloplasty keeping in mind CRV in all patients , so inadvertent injuries to crossing renal vessels can be avoided.

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