Diagnostic ultrasound ( PDFDrive )

CHAPTER 52 The Pediatric Urinary Tract and Adrenal Glands 1793
A B C
FIG. 52.25 Infected Urachal Cyst. (A) Longitudinal image shows a complex, lobulated mass (arrows) adjacent to the superior aspect of the
bladder (B). *, Free pelvic luid. (B) Transverse image of the mass depicts increased through transmission of sound (arrowheads) in keeping with
the luid nature of the lesion. (C) Color Doppler image depicts hyperemia at the periphery of the lesion indicative of its inlammatory nature.
A
B
FIG. 52.26 Acute Pyelonephritis in 2-Month-Old Girl. (A) Longitudinal image demonstrates a swollen, echogenic upper pole with loss of
normal corticomedullary differentiation (arrows). (B) Power Doppler sonography reveals markedly diminished blood low in this region.
A
B
FIG. 52.27 Thickening of the Renal Pelvic Wall. (A) and (B) Longitudinal and transverse images demonstrate thickening of the renal pelvic
wall (arrows), which can occur as a result of inlammation or relux, as well as after relief of obstruction.
may demonstrate a focal mass of variable echogenicity with
ill-deined borders. CT is considered a more sensitive and accurate
imaging modality for the diagnosis of acute lobar nephronia.
Afected patients have a more protracted clinical course than
those with acute pyelonephritis, and there is a higher incidence
of renal scarring. 75 If response to antibiotic therapy is inadequate,
the mass may liquefy centrally and become a renal abscess that
requires drainage. Sonography of an abscess shows a focal mass
with a hypoechoic central area representing liqueied pus
(Fig. 52.28).
Another potential complication of acute pyelonephritis that
requires drainage is pyonephrosis, which appears on sonography
as echogenic material illing a dilated collecting system
(Fig. 52.29).