Diagnostic ultrasound ( PDFDrive )

332 PART II Abdominal and Pelvic Sonography
A
B
FIG. 9.32 Renal Hydatid Cyst. (A) Sagittal sonogram shows a complex multiloculated lower-pole cystic mass (arrows). (B) Contrast-enhanced
CT shows multiple conluent daughter cysts. (Courtesy of Drs. Vikram Dogra and Suleman Merchant.)
A
B
FIG. 9.33 Proven Pneumocystis Nephropathy in a Patient With AIDS. (A) Sagittal and (B) transverse sonograms show multiple scattered
echogenic foci within the renal parenchyma. Some foci demonstrate the distal acoustic shadowing of calciication. Similar indings are seen in the
liver. (With permission from Spouge AR, Wilson S, Gopinath N, et al. Extrapulmonary Pneumocystis carinii in a patient with AIDS: sonographic
indings. AJR Am J Roentgenol. 1990;155:76-78. 66 )
Early literature noted the increased incidence of opportunistic
genitourinary infections (cytomegalovirus [CMV], Candida
albicans, Cryptococcus, Pneumocystis jiroveci [formerly P. carinii],
Mycobacterium avium-intracellulare, Mucormycosis) and tumors
(lymphoma, Kaposi sarcoma) in these immunocompromised
patients. 65 he appearance of these infections is oten nonspeciic
(and now rare), but difuse visceral/renal calciications suggest
disseminated P. jiroveci, CMV, or M. avium-intracellulare
infections 66-68 (Fig. 9.33). he genitourinary infections that now
occur in these patients, including pyelonephritis, renal abscesses,
and cystitis, are similar to those seen in non–HIV-infected
individuals.
Use of HAART has also changed the spectrum of chronic
renal diseases seen in HIV-positive patients. he incidence of
ESRD in HIV patients decreased initially ater the institution of
HAART; however, the increased prevalence of HIV in the US
population has resulted in an increased number of patients with
HIV-associated nephropathy (HIVAN). 69 In HIV-positive
patients, HIVAN is the most common cause of chronic kidney
disease; black patients are at particular risk. he histologic
hallmark of HIVAN is focal segmental glomerulosclerosis.
Nephropathy in HIV-positive patients may also be caused by
HIV immune complex disease and HIV thrombotic microangiopathy.
Adverse renal efects of various drugs also complicate
the diagnosis of chronic renal failure. 70 However, other disease
processes not directly associated with HIV infection (e.g.,
hypertension, diabetic nephropathy, interstitial nephritis) may
result in ESRD in patients successfully treated with HAART. 71
Deinitive diagnosis of HIVAN is usually made ater renal biopsy.
Renal sonography is useful in these patients to exclude obstruction