[Infected upper renal pole in a duplex system with paravaginal abscess]

Diagnosis of afunctional duplex systems may be delayed as they are often associated with misleading and atypical symptoms. A 40-year-old female with no history of urological disease exemplifies this thesis.

Symptoms at admission were fever with pain in the right flank and lower abdomen. Sonography showed a large unclear structure at the upper pole of the right kidney and a paravaginal abscess, which was drained primarily. Rising temperature led to examination by CT-scan, which revealed a renal abscess of the upper pole, suggesting a right extopic ureter. After percutaneous drainage, further examinations (antegrade pyelography and IVP) confirmed an ectopic, blind-ending duplex ureter with a hydropyonephrotic upper renal system on the right side. Upper poole resection with ureterectomy was performed.

In patients with unclear abscesses in the area of the external genitalia, congenital anomalies of the urinary tract should be considered as an underlying disease.