Bilateral giant orthotopic ureterocele appearing as kissing cobra in a Nigerian child

The cobra head sign is classically seen when a unilateral intravesical ureterocele is present. This type of ureterocele is also termed orthotopic. Orthotopic ureteroceles are usually unilateral and commoner in females, but bilateral in 10% of cases.The cobra head sign is characterised by bulbous dilatation of the distal end of the ureter with a surrounding radiolucent halo seen within the contrast-filled urinary bladder on intravenous urograms. Although, the cobra head sign is classic for an intravesical ureterocele, only about 50% of cases show this sign. This is a rare case of an eleven-year old boy with giant bilateral ureterocele touching each other on intravenous urogram, hence appearing as 'kissing cobra'.