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Age: 3

Sex: Female

Indication: Abdominal pain

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Case #11


Findings

  • Severe right hydronephrosis with echogenic material layering in the right renal pelvis and calyces
  • Urothelial thickening of the right renal collecting system
  • Increased echogenicity of the right renal parenchyma
  • Normal appearance of the left kidney
  • Urinary bladder is incompletely distended but otherwise normal in appearance


Diagnosis

Pyonephrosis

Sample Report

Severe right hydronephrosis with urothelial thickening and echogenic material layering in the right renal pelvis and calyces, concerning for pyonephrosis. Recommend urology evaluation.

Increased echogenicity of the right renal parenchyma is suggestive of associated pyelonephritis.

Normal appearance of the left kidney and urinary bladder.


Discussion

  • Pyonephrosis is a feared condition that can occur with, or result in urinary tract obstruction and commonly requires urgent decompression of the renal collecting system – this patient went on to percutaneous nephrostomy tube placement
  • On ultrasound, look for echogenic material in the renal collecting system and hydronephrosis
  • If hydronephrosis is present, look for a potential underlying cause, such as an obstructing ureteral calculus, which may have led to urinary stasis and predisposed to superinfection
  • Further imaging studies on this child showed a likely congenital UPJ obstruction
  • Make sure to also assess for gas in the collecting system and renal parenchyma in these cases


Images

Fluid-debris level in the dilated right renal pelvis (red arrow), worrisome for pyonephrosis.

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