Clinical Practice and Cases in Emergency Medicine

Introduction: Retrocaval ureter (RCU) is a rare congenital anomaly resulting from abnormal development of the inferior vena cava, leading to ureteral obstruction and hydronephrosis. Patients often present with nonspecific symptoms, making diagnosis challenging. Point-of-care ultrasound (POCUS) is frequently used in the emergency department (ED) to evaluate abdominal pain and may identify clinically important abnormalities requiring further investigation.

Case Report: A 30-year-old woman presented to the ED with a two-day history of nonspecific abdominal pain. Physical examination was notable only for mild epigastric tenderness. Abdominal POCUS performed by the emergency physician demonstrated moderate right-sided hydronephrosis. The patient had no urinary symptoms and normal renal function. Follow-up renal ultrasound confirmed hydronephrosis and proximal hydroureter without nephrolithiasis. Contrast-enhanced computed tomography subsequently revealed a RCU with the characteristic fish-hook configuration. Renography demonstrated preserved renal function with delayed drainage secondary to ureteral obstruction. The patient underwent surgical correction with ureteral reconstruction and stent placement.

Conclusion: This case highlights the value of POCUS in the evaluation of patients with nonspecific abdominal pain. Detection of hydronephrosis prompted further diagnostic evaluation and led to the diagnosis of a rare congenital urologic anomaly requiring surgical intervention. Emergency physicians should consider further investigation when hydronephrosis is identified on POCUS, even in the absence of urinary symptoms.