Question

A female patient presented with recurrent urinary tract infections. Imaging shows the following picture. What can be the most probable diagnosis?

• A. Duplication of ureter
• B. Congenital megaureter
• C. Ureterocele
• D. Urinary stones

Hint:

A cobra-head sac with a radiolucent halo at the distal ureter and recurrent UTIs means ureterocele.

Answer 1

The Correct Option is C

Step 1: The plain radiograph shows no calcification along the urinary tract, which immediately makes urinary stones unlikely. After intravenous contrast, the left distal ureter dilates into a rounded contrast-filled sac.
Step 2: This sac produces a cobra-head (or spring-onion) appearance surrounded by a radiolucent halo. These signs are diagnostic of an intravesical ureterocele of the left ureter.
Step 3: A ureterocele is an abnormal cystic dilatation of the distal ureteric segment. It has a female predilection and is associated with ureteric duplication in about 75% of cases. It can be simple or ectopic, and urinary stasis within it explains the recurrent UTIs.
Step 4: Duplication of the ureter (option a) alone does not give the cobra-head sac, congenital megaureter (option b) dilates the whole ureter uniformly, and urinary stones (option d) are excluded by the absence of calcification, so all are incorrect.