Diagnosis of intermittent hydronephrosis on multiphase CT intravenous pyelogram and [99mTc]Tc-MAG3 study-Homsy sign.

A 40-year-old female was investigated for intermittent right flank pain and management of large uterine fibroids. A multiphase CT intravenous pyelogram showed the development of mild right hydronephrosis and hydroureter between the non-contrast and delayed pyelogram phases of imaging, secondary to large uterine fibroids compressing the pelvic course of the right ureter. The MAG3 renography demonstrated an initial downsloping renogram followed by rapid upsloping and increased renal cortical uptake during forced diuresis, accompanied by clinical symptoms. These findings indicate intermittent obstruction, also known as the Homsy sign.