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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
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)
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 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