Wk 2, Case 4 - Review

EXAM: Renal Ultrasound (US)

INDICATION: 8-year-old girl with urinary tract infections.

TECHNIQUE: Multiple grayscale and color Doppler sonographic images were obtained of the kidneys and bladder.

FINDINGS:

On the left kidney, there is a duplication of the renal collecting system, with a band of echogenic parenchyma separating the superior from the inferior medullary spaces. There is prominent (Grade III) hydronephrosis of the upper moiety, and minimal (grade I) hydronephrosis of the lower moiety.

There is normal appearance of the right kidney and bladder.

IMPRESSIONS:

Duplicated left renal collecting system, with grade III hydronephrosis of the upper moiety and grade I of the lower moiety.

EXAM: Fluoroscopic voiding cystourethrogram (VCUG)

INDICATION: 8-year-old girl with urinary tract infections.

TECHNIQUE: Multiple fluoroscopic images were obtained during the passive retrograde infusion of contrast into the bladder until full, and during voiding.

FINDINGS:

Retrograde filling of the bladder reveal vesicoureteral reflux (VUR) into duplicated ureters. Reflux into the lower moiety reveals mild VUR without significant dilatation of the renal pelvis. Reflux into the ectopic ureter of the upper moiety reveals severe VUR with an enlarged and featureless renal pelvis. There is a ureterocele visualized at the ureterovesicle junction (UVJ) of the ectopic ureter.

Mild reflux is noted on the right. The patient voided the bladder with mild post-void residual bladder volume.

IMPRESSIONS:

1. Duplex left collecting system with grade V VUR of the upper moiety and grade I VUR of the lower moiety. There is a ureterocele at the ectopic ureter’s insertion on the bladder.
2. Grade I VUR on the right.