Q: What are the two urinary tract abnormality seen in the case? Are they associated with each other?
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A: A) Duplex left kidney, with hydronephrotic left upper moiety, and B) ureterocele at the left vesicoureteric junction. Usually, the upper moiety of a duplex kidney is associated with ureterocele at the distal end, causing proximal hydroureteronephrosis.
Q: While obsessed with this urinary tract anomaly, did you notice any traumatic injuries?
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A: Posterior dislocation of the left hip with an associated acetabular fracture...
Q: What would have been a classical signs seen on IVP of this patient?
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A: A) Drooping lily sign in the left pelvicalyceal system, due to inferior displacement of lower pole calyces by hydronephrotic upper moiety.
B) "Adder head sign" or "cobra head sign" of the ureterocele surrounded by contrast in the bladder.
Q: What is the Weigert-Meyer law?
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A: The Weigert-Meyer law describes the relationship of the upper and lower renal moieties in duplicated collecting systems to their drainage inferiorly. The upper pole moiety ureter drains ectopically, infero-medial to the normal lower moiety ureter.
Q: If the lower pole of a duplex kidney is hydronephrotic, what would be the most likely cause?
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A: Chronic vesicoureteric reflux (reflux nephropathy) due to distorted insertion of ureter due to ureterocele.