Diagnostic ultrasound ( PDFDrive )

1794 PART V Pediatric Sonography
A B C
FIG. 52.28 Renal Abscess. (A) Longitudinal image of the right kidney reveals upper-pole swelling with loss of normal corticomedullary differentiation
(arrows). (B) Transverse image of the right upper renal pole depicts an irregular intraparenchymal luid collection (arrows). (C) Power Doppler
image of the right upper pole shows diminished blood low as well as the intraparenchymal luid collection (arrows). L, Liver.
A
B
FIG. 52.29 Pyonephrosis in a 4-Month-Old Infant With Underlying Ureteropelvic Junction Obstruction. (A) and (B) Sagittal and transverse
images of the left kidney depict moderate hydronephrosis with echogenic material in the collecting system and a prominent luid-luid level in the
renal pelvis (arrows).
Chronic Pyelonephritis
Chronic pyelonephritis is caused by repeated episodes of acute
pyelonephritis and results in a small, scarred kidney, indicative
of end-stage renal disease. he kidney is usually irregular in
outline because of focal parenchymal loss. he renal cortex is
typically more echogenic than the adjacent hepatic or splenic
parenchyma, and there may be decreased corticomedullary
diferentiation (Fig. 52.30). hese indings are not speciic and
can also be seen in children with chronic glomerulonephritis,
renal dysplasia, hypertension, or renal ischemia.
Neonatal Candidiasis
Candida albicans is a saprophytic fungus that usually infects
immunocompromised patients, particularly neonates with
indwelling catheters receiving broad-spectrum antibiotics.
Systemic candidiasis leads to infection of multiple organs, including
the kidneys, and neonates may have anuria, oliguria, a lank
mass, or hypertension. Sonography may show difuse enlargement
of the kidney, with loss of normal architecture and increased
parenchymal echogenicity. Fungus ball formation due to mycelial
clumping may occur in the collecting system, resulting in
echogenic masses and hydronephrosis secondary to obstruction 76
(Fig. 52.31).
Cystitis
Inlammation of the urinary bladder may occur in children as
a result of infection or drug therapy, as with the antineoplastic
agent cyclophosphamide. he bladder wall becomes thickened
and irregular, with hypervascularity identiied with color and
power Doppler imaging. Echogenic debris or blood clot may be
seen in the bladder lumen 77 (Fig. 52.32). Rarely, an inlammatory
pseudotumor may result, with visualization of a bladder mass 78
(Fig. 52.33, Video 52.5).
MEDICAL RENAL DISEASE
he term “medical renal disease” refers to disorders that primarily
afect the renal parenchyma and may be acute or chronic.
Ultrasound is usually the initial imaging study performed in the