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ABDOMINAL ULTRASOUND
A
B
C
D
Figure 9.9 Renal dilatation. (A) Dilatation of the pelvicalyceal system (PCS) due to pelviureteric junction obstruction.
(B) TS of the same kidney. The ureter was not dilated. (C) Duplex RK with gross dilatation of the lower pole moiety
containing echoes due to infection. The cortex is thin. The smaller upper pole moiety is also dilated. A ureterocoele was
present at the right vesioureteric junction (VUJ). (D) Mild dilatation of the LK. An anteroposterior (AP) measurement of
the PCS provides a good baseline for follow-up.
and likely to require an assessment of renal function
with a MAG3 renogram. Conservative treatment is
possible, but surgery may be required for very poor
function.
The dilated renal tract is predisposed to infection
due to ascending infection in reflux or haematogenous
infection in an obstructed system, where a
pyonephrosis requiring percutaneous nephrostomy
may develop. As a consequence antibiotic prophylaxis
is frequently advised in the neonate with significant
renal tract dilatation.
Bilateral renal tract dilatation in boys may be due
to posterior urethral valves with secondary dilatation
of the upper tracts due to the urethral obstruction.
The diagnosis is confirmed by fluoroscopic micturating
cystography. This diagnosis may be suspected
sonographically by the association of bilateral
hydronephrosis with a distended and thick-walled
bladder.
Vesicoureteric reflux
Vesicoureteric reflux, the retrograde passage of
urine from the bladder up the ureter and into the
kidney, predisposes the child to urinary tract infection
and the development of reflux nephropathy.
In the first year of life only, reflux is more common
in boys than in girls and is usually more