title: Diagnosis of megaureter by point-of-care ultrasound.
abstract: BACKGROUND
  Presentation of congenital megaureter in adult life is rare; patients usually become symptomatic in childhood.
  
  
  METHODS
  A 32-year-old man presented to the Emergency Department (ED) with dyspnea, tongue swelling, and a rash, which he attributed to amoxicillin he had taken shortly prior to onset of symptoms. He was hypotensive on arrival to the ED. To further evaluate the hypotension, point-of-care ultrasound of the heart, lungs, and abdomen were performed while treatment for anaphylaxis was initiated. Ultrasound examination did not identify a cause for hypotension, but the treating physician noted an anechoic structural abnormality posterior to the bladder, suggestive of megaureter. The patient responded well to treatment of anaphylaxis; further history and diagnostic imaging subsequently confirmed a diagnosis of congenital megaureter.
  
  
  CONCLUSIONS
  We report an unusual case of congenital megaureter, identified by point-of-care ultrasound performed to evaluate hypotension. Clinicians performing limited ultrasound examinations must be attentive to incidental findings that will require follow-up.
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David C
authors.initials: DC
authors.lastname: Mackenzie
authors.affiliation: Department of Emergency Medicine, Harborview Medical Center, Seattle, Washington.
authors.forename: Dana
authors.initials: D
authors.lastname: Sajed
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000139:chemically induced / Q000628:therapy; D006801:Humans; D007022:Hypotension / Q000209:etiology; D033162:Incidental Findings; D008297:Male; D019095:Point-of-Care Systems; D011859:Radiography; D014463:Ultrasonography; D014513:Ureter / Q000002:abnormalities* / Q000000981:diagnostic imaging*
keywords: bedside; congenital; emergency department; megaureter; point-of-care; ultrasound; urology