9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

THE PAEDIATRIC ABDOMEN 231
A
LT
B
C
Figure 9.12 (A) Large Wilms’ tumour arising in the left kidney and filling the left flank with a solid, heterogeneous
mass. (B) Xanthogranulomatous pyelonephritis was the cause of the renal mass in this 8-year-old boy presenting with
anaemia and a flank mass. (C) Renal vein thrombosis in a dehydrated neonate, showing an enlarged ‘globular’ kidney
with loss of the normal corticomedullary differentiation.
CT scanning may also be helpful. The kidney will
usually be found to be non-functioning on a
DMSA scan and nephrectomy is required.
Renal vein thrombosis (RVT)
RVT primarily occurs in the neonatal period but
may occur in the older child, particularly in association
with renal malignancy and amyloidosis.
Classically the sick neonate is noted to develop gross
haematuria in association with a palpable abdominal
mass. RVT is usually unilateral but may be bilateral
and is associated with acute adrenal haemorrhage
when left-sided. Sonographically the affected kidney
is enlarged and globular and develops an inhomogeneous
echogenicity of the renal parenchyma with
areas of increased echogenicity due to haemorrhage
(Fig. 9.12C). Thrombus may be detected in the