Diagnostic Ultrasound - Abdomen and Pelvis
Hypoechoic Kidney • Multiple Myeloma ○ Bilateral nephromegaly ○ Decreased echogenicity ○ Nephrocalcinosis or urate calculi may be present • Renal Leukemia ○ Leukemia may cause diffuse hypoechoic enlargement or focal masses • Renal Lymphoma ○ Hypoechoic enlarged kidneys represent one phenotype of renal lymphoma ○ Associated with lymphadenopathy and perirenal rind ○ Rarely confined to kidneys • Hypoechoic Renal Fat With Atrophic Kidneys ○ Prominent hypoechoic perirenal fat may be mistaken for kidneys when kidneys are atrophic and indistinct Helpful Clues for Rare Diagnoses • Acute Amyloidosis ○ Uncommon disease ○ Amyloid deposition is common in kidneys, particularly glomeruli ○ Amyloid nephropathy associated with proteinuria and renal insufficiency ○ Enlarged hypoechoic kidney due to deposition of amyloid fibrils ○ Later, kidneys may be echogenic and small • Acute Cortical Necrosis ○ Hypoechoic cortex ○ Loss of corticomedullary differentiation ○ May subsequently become calcified • Xanthogranulomatous Pyelonephritis ○ Enlarged kidney with dilated calyces ○ Staghorn calculus, perinephric collection ○ Hypoechoic/anechoic round collections ○ Chronic obstruction secondary to calculus with infection and development of cystic spaces 2. Rodgers SK et al: Ultrasonographic evaluation of the renal transplant. Radiol Clin North Am. 52(6):1307-24, 2014 3. Dedekam E et al: Primary renal lymphoma mimicking a subcapsular hematoma: a case report. J Radiol Case Rep. 7(8):18-26, 2013 4. Bach AG et al: Prevalence and patterns of renal involvement in imaging of malignant lymphoproliferative diseases. Acta Radiol. 53(3):343-8, 2012 5. Herts BR: Renal lymphoma presenting as an incidental renal mass. J Urol. 188(1):271-3, 2012 6. Le O et al: Common and uncommon adult unilateral renal masses other than renal cell carcinoma. Cancer Imaging. 12:194-204, 2012 7. Piscaglia F et al: The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 33(1):33-59, 2012 8. Raman SP et al: Beyond renal cell carcinoma: rare and unusual renal masses. Abdom Imaging. 37(5):873-84, 2012 9. Roy A et al: Common and uncommon bilateral adult renal masses. Cancer Imaging. 12:205-11, 2012 10. Smith AD et al: Bosniak category IIF and III cystic renal lesions: outcomes and associations. Radiology. 262(1):152-60, 2012 11. Taneja R et al: Common and less-common renal masses and masslike conditions. Radiol Clin North Am. 50(2):245-57, v-vi, 2012 12. Elsayes KM et al: Imaging of renal transplant: utility and spectrum of diagnostic findings. Curr Probl Diagn Radiol. 40(3):127-39, 2011 13. Israel GM et al: The incidental renal mass. Radiol Clin North Am. 49(2):369-83, 2011 14. Kitazono MT et al: CT of unusual renal masses invading the pelvicaliceal system: potential mimics of upper tract transitional cell carcinoma. Clin Imaging. 35(1):77-80, 2011 Differential Diagnoses: Kidney SELECTED REFERENCES 1. Hammond NA et al: Imaging of adrenal and renal hemorrhage. Abdom Imaging. ePub, 2015 Acute Pyelonephritis Severe Fatty Liver (Mimic) (Left) Longitudinal ultrasound of the right kidney in acute uncomplicated pyelonephritis shows an enlarged hypoechoic kidney ſt with loss of corticomedullary differentiation st. (Right) Longitudinal ultrasound shows a large fatty liver causing the normal right kidney to appear hypoechoic st. 957
Hypoechoic Kidney Differential Diagnoses: Kidney (Left) Longitudinal ultrasound of the right kidney in a patient with sepsis, liver disease, and acute kidney injury shows loss of corticomedullary differentiation and a perirenal rind of fluid ſt in addition to ascites st. (Right) Longitudinal ultrasound of a renal transplant with delayed graft function from acute tubular necrosis shows loss of corticomedullary differentiation ſt. Renal Parenchymal Disease Renal Parenchymal Disease (Left) Longitudinal ultrasound of the right renal fossa shows a hypoechoic reniform structure st with some posterior acoustic enhancement ſt. Normal kidney could not be seen. (Right) Axial T2 HASTE MR in the same patient shows a large subcapsular collection ſt compressing the kidney st. Drainage of the collection revealed abscess. Perinephric Hematoma or Other Fluid Collection Perinephric Hematoma or Other Fluid Collection (Left) Longitudinal ultrasound of a renal transplant with acute renal vein thrombosis shows renal edema st and urothelial thickening ſt. Percutaneous ultrasoundguided biopsy showed cellmediated rejection. (Right) Longitudinal power Doppler ultrasound of a renal transplant shows almost complete absence of intrarenal flow with a patent segmental artery ſt. The kidney is swollen and hypoechoic. Acute Renal Transplant Rejection Acute Renal Vein Thrombosis 958
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- Page 930 and 931: Focal Gallbladder Wall Thickening/M
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- Page 936 and 937: Dilated Gallbladder Mucocele/Hydrop
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- Page 940 and 941: PART III SECTION 3 Pancreas Cystic
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- Page 960 and 961: PART III SECTION 5 Urinary Tract 9
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- Page 1000 and 1001: PART III SECTION 7 Abdominal Wall/P
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- Page 1012 and 1013: PART III SECTION 8 Prostate Enlarge
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- Page 1020 and 1021: PART III SECTION 9 Bowel Bowel Wall
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Hypoechoic Kidney<br />
Differential Diagnoses: Kidney<br />
(Left) Longitudinal ultrasound<br />
of the right kidney in a patient<br />
with sepsis, liver disease, <strong>and</strong><br />
acute kidney injury shows loss<br />
of corticomedullary<br />
differentiation <strong>and</strong> a perirenal<br />
rind of fluid ſt in addition to<br />
ascites st. (Right)<br />
Longitudinal ultrasound of a<br />
renal transplant with delayed<br />
graft function from acute<br />
tubular necrosis shows loss of<br />
corticomedullary<br />
differentiation ſt.<br />
Renal Parenchymal Disease<br />
Renal Parenchymal Disease<br />
(Left) Longitudinal ultrasound<br />
of the right renal fossa shows<br />
a hypoechoic reniform<br />
structure st with some<br />
posterior acoustic<br />
enhancement ſt. Normal<br />
kidney could not be seen.<br />
(Right) Axial T2 HASTE MR in<br />
the same patient shows a<br />
large subcapsular collection<br />
ſt compressing the kidney st.<br />
Drainage of the collection<br />
revealed abscess.<br />
Perinephric Hematoma or Other Fluid<br />
Collection<br />
Perinephric Hematoma or Other Fluid<br />
Collection<br />
(Left) Longitudinal ultrasound<br />
of a renal transplant with<br />
acute renal vein thrombosis<br />
shows renal edema st <strong>and</strong><br />
urothelial thickening ſt.<br />
Percutaneous ultrasoundguided<br />
biopsy showed cellmediated<br />
rejection. (Right)<br />
Longitudinal power Doppler<br />
ultrasound of a renal<br />
transplant shows almost<br />
complete absence of<br />
intrarenal flow with a patent<br />
segmental artery ſt. The<br />
kidney is swollen <strong>and</strong><br />
hypoechoic.<br />
Acute Renal Transplant Rejection<br />
Acute Renal Vein Thrombosis<br />
958
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