• David C Mackenzie, Dana Sajed, and Vicki E Noble.
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
• J Emerg Med. 2014 Jul 1;47(1):e1-3.

BackgroundPresentation of congenital megaureter in adult life is rare; patients usually become symptomatic in childhood.Case ReportA 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.ConclusionWe 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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