A Diagnostic Pitfall in a Patient with Acute Abdominal Pain: Congenital Hydronephrosis/Hydroureter Misdiagnosed as Hydrosalpinx

Abstract

Clinical manifestation or incidental finding of congenital kidney anomalies are more often discovered during pregnancy. Even if the acute presentation (in the antenatal period, as in this case) precludes a full diagnostic workup, assiduous follow-up and investigations in the postnatal period will resolve the initial uncertainty. This is not a new phenomenon based on literature and urologic differential diagnoses such as an ectopic urinary system which should always be entertained and excluded prior to making the diagnosis of an adnexal mass. We present a case of 33-year-old woman with acute abdominal pain and a previous obstetric (mis)diagnosis of hydrosalpinx (based on ultrasonography) made 8 years before presenting to the emergency department with acute lower abdominal pain, fever, chills and rigors. Current investigations revealed congenital abnormal kidneys bilaterally, with ectopic left kidney and grossly infected hydronephrosis, which was likely the fluid-filled mass initially mistaken for a hydrosalpinx. She then underwent left nephrostomy and later had simple left nephrectomy. This case highlights the importance of making an accurate diagnosis and arranging careful follow-up of the female patient presenting with a “cystic” mass of the pelvic region during pregnancy.