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Age: 66

Sex: Female

Indication: Progressive renal failure

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Case #49


Findings

  • Heterogeneous bilateral renal echotexture with numerous hyperechoic foci
  • Hypoechoic structure in the upper pole of the right kidney measuring up to 8 mm with posterior acoustic enhancement, consistent with a cyst
  • No hydronephrosis
  • Urinary bladder is decompressed, limiting assessment


Diagnosis

Lithium-induced nephropathy

Sample Report

Heterogeneous bilateral renal echotexture with numerous hyperechoic foci. Recommend correlation with history of lithium use as this appearance is typical for lithium-induced nephropathy.

No hydronephrosis.

Urinary bladder is decompressed, limiting assessment.


Discussion

  • Lithium is a well-known cause of tubulointerstitial nephritis, which results in the formation of numerous microcysts in the kidneys
  • On ultrasound, numerous tiny cysts and/or echogenic foci may be observed
  • The echogenic foci likely relate to microcysts rather than calcification and may represent a colloid-like material within tiny cysts or posterior acoustic enhancement associated with otherwise invisible cysts
  • The radiologist plays an important role in making this diagnosis since symptoms are nonspecific and renal failure may not clinically manifest until years after cessation of lithium therapy



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