Sonography of kidneys-2

Lupus-nephritis

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Assorted ultrasound cases- by Joe Antony, MD

-This 15 yr old female patient showed mild pleural effusion and ascites on ultrasound imaging of the abdomen. Other ultrasound findings (see images above):

-kidneys appear enlarged and edematous with loss of cortico-medullary differentiation

-increased echogenicity of the renal cortex.

-also present: abuminuria and serum creatinine of 1.4 mg %

On renal biopsy it was diagnosed as membranous lupus nephritis or SLE (Systemic lupus erythematosus) involving the kidneys. Lupus nephritis is graded from 1 to 6 depending on clinical and pathological findings.

In chronic lupus nephritis, the kidneys may show typical songraphic features of medical renal disease with small echogenic kidneys.

References: sonography of lupus nephritis

                    Imaging in SLE (RSNA)

perinephric-fluid-abscess

Elderly male patient with severe UTI (urinary tract infection).

Here ultrasound scan shows sediment containing particulate matter in urinary bladder.

Also a perinephric hypoechoic collection around the lower half of both kidneys.

This suggests bilateral perinephric abscess.

D/d -urinoma or extravasated urine

       -hemorrhagic fluid (perinephric hematoma)

       -lymphatic fluid

Looking to the history of severe UTI and findings, the diagnosis of perinephric abscess is likely.

References: Perinephric fluid or abscess-ultrasound imaging

 

dromedary-hump-left-kidney

Dromedary hump of left kidney:

= a hump or lump bulging from the superior and lateral spect of the kidney

= always affects the left kidney and is due to the spleen compressing upon the left kidney

= name dromedary hump is derived from the hump seen in dromedary camels

= D/d: must be distinguished from renal masses. Here (dromedary humps) margins are well defined and show normal renal vessels on color Doppler ultrasound imaging

= clinically not significant; follow up will show no change in characteristics on ultrasound/ sonography

 

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