Kidneys

A free gallery of high-resolution, ultrasound, color doppler and 3D images

Ultrasound images of diseases of the kidneys:

Normal variants:

Fetal lobulation of kidneys:

This patient, an adult female underwent routine sonography of the abdomen. Ultrasound images of the kidneys reveal multiple indentations (short arrows) of the renal cortex, with no evidence of fibrotic tissue (would be seen as hyperechoic bands). There is no evidence of thinning of the renal cortex or deformity of the pelvicalyces (ruling out chronic pyelonephritis). These ultrasound images show typical appearance of renal fetal lobulation. Fetal lobulation is a common finding and is a normal variant of the kidneys. It is caused by the persistence, into adult life, of the lobulation of the kidneys seen normally during fetal stage.

SONOGRAPHY OF RENAL PATHOLOGY:

1) Autosomal Dominant Polycystic Kidney Disease (ADPCK):

Sonography of this 55 yr. old male patient, who presented with hematuria, reveal bilateral grossly enlarged kidneys (14 to 16 cms. in length, 8 to 10 cms. width). The kidneys are replaced by multiple large cysts (more than 2 in each kidney) of sizes varying from 2 to 5 cms. (Criteria for diagnosis of ADPCK: a) more than 2 renal cysts in one/ both kidneys, if age less than 30 yrs. b) 2 or more cysts in each kidney, if aged from 30 to 59 yrs. c) 4 cysts in each kidney if aged more than 60 yrs.) There is very little normal renal parenchyma seen in these images. Note that the cysts are non-communicating ruling out hydronephrosis. The right kidney shows an echogenic focus, in one cyst, which may be a calculus or calcification. A solitary cyst is seen in the right lobe of liver. These ultrasound images are diagnostic of Autosomal Dominant Polycystic Kidney (ADPCK) disease.

References:

1) http://en.wikipedia.org/wiki/Polycystic_kidney_disease (free article)

2) http://www.emedicine.com/med/topic1862.htm (free article)

See this link: http://www.ultrasound-images.com/fetal-urogenital.htm for cases/ ultrasound images of autosomal recessive polycystic kidney disease- ARPKD where I have posted some images of fetal polycystic kidneys.

2) CYSTIC LESIONS OF THE KIDNEYS:

A) Cortical cysts or simple renal cyst:

Case-1:

Case-2:

The above ultrasound images show solitary cortical cysts of the kidney. These are seen as single, well defined cystic lesions mainly involving the renal cortex and have thin walls. There is also acoustic enhancement posteriorly. The Power Doppler image (top row- right) shows blood vessels curving around the cyst. Cortical cysts are usually a benign condition requiring follow up to look for changes such as infection, rupture or increase in size.

Reference: http://emedicine.medscape.com/article/453831-diagnosis

B) Calyceal diverticulum or calyceal cyst:

The above B-mode ultrasound image (left) and Color Doppler image (right) show a cystic lesion involving the collecting system (middle calyx) of the right kidney. This suggests a calyceal diverticulum /calyceal cyst of the right kidney. The walls of the cystic lesion are thin but irregular and possibly communicate with the renal pelvis. Again, in this case too, the cyst appears to displace blood vessels which surround the lesion.

Reference: http://www.radswiki.net/main/index.php?title=Calyceal_diverticulum

C) Milk of Calcium cyst:

The above ultrasound images of the right kidney show echogenic debris layering at the dependent part of a small cyst. There is change in the fluid-debris interphase with change in position. There is minimal acoustic shadowing due to a relatively large amount of calcium debris. These are typical findings of Milk of Calcium within a renal cyst. Images courtesy of Dr. Ravi Kadasne, UAE.

Reference: 1) http://www.jultrasoundmed.org/cgi/content/abstract/11/5/195

2) http://www.sonoworld.com/Article/ShowArticleDetails.aspx?aid=20 (free article-- rated by us- excellent)

3) Pseudoaneurysm in Transplanted kidney:

Sonographic imaging was done on this patient who underwent renal transplant some time ago. The transplanted kidney is seen in the left iliac fossa in these ultrasound images. The first image shows a cystic lesion (anechoic) in the lower pole of transplanted kidney. The 2nd image also shows mild dilation of the renal pelvis and upper ureter in this kidney. Color doppler images reveal swirling flow pattern within the cystic lesion. There is also evidence of a communication of the lesion with a segmental artery. Real time imaging also revealed to and fro flow between the lesion and the artery. Diagnosis: pseudoaneurysm in transplant kidney. Images courtesy of Dr. Jaydeep Gandhi, Mumbai, India.

Reference: http://www.sonoworld.com/Sonoworld/Cases/Cases.aspx?CaseID=363 (free article)

4) Ectopic/ Pelvic kidney:

This female patient underwent routine abdominal ultrasound imaging. These ultrasound images show the right kidney just to the right of the uterus in the true pelvis. There was no kidney visualized in the right renal fossa. These sonographic images are diagnostic of ectopic kidney (in this case, a pelvic kidney). It is unusual to see the pelvic kidney so low down in the pelvis. Images courtesy of Dr. Ravi Kadasne, UAE.

Reference:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1398389 (free article)

5) Horseshoe kidney:

Routine abdominal sonography of the abdomen in this patient revealed: a) kidneys located at a lower level than normal b) the lower poles of both kidneys pointing medially, c) a bridge of renal tissue or isthmus connecting the two kidneys. This isthmus is seen passing anterior to the abdominal aorta. Often, the lower poles of the kidneys are difficult to visualize in such cases. These ultrasound images are diagnostic of horseshoe kidney. Images taken by Dr. Ravi Kadasne, UAE, using a Toshiba Powervision ultrasound machine.

The above color doppler images show a large isthmus lying anterior to the abdominal aorta.

Images courtesy of Dr. G. V. Ramaiah, AP, India.

References: E-medicine article on Horseshoe kidney (free article and images- rated comprehensive)

6) Renal cell carcinoma:

This 57 yr. old male patient presented with abdominal pain and mass in abdomen. Sonography reveals a large, hypoechoic, inhomogenous mass (10 x 8 cms.) at the upper pole of the left kidney. The central portion is markedly hypoechoic suggestive of necrosis. The left renal vein appears normal. The right kidney shows a small cortical cyst and mild pelvic dilation. The urinary bladder was normal (not shown here). CT scan images confirm the large left renal mass with enhancement of the tumour and necrotic central area. These ultrasound images are suggestive of renal cell carcinoma. Ultrasound images taken with Toshiba Power Vision machine, courtesy of Dr. Ravi Kadasne, UAE.

Reference: http://www.emedicine.com/med/topic2002.htm (free article)

Case-2 (Renal cell carcinoma):

Another case of renal cell carcinoma. This elderly male patient presented with hematuria. Sonography of the left kidney shows a large, solid mass (11 x 8 cms.) involving the upper half of the left kidney. The affected kidney shows mild obstructive changes. Power Doppler image (bottom left) shows multiple vessels entering the mass. Transverse section of the liver and pancreas (ultrasound image on bottom right) shows the mass to be in close relation to the tail of pancreas. (Liv= Liver, Pan = pancreas, PV= Portal vein, AO = aorta, IVC= Inferior Vena Cava).

7) Chronic renal failure (Medical renal disease):

This elderly male patient presented with symptoms of medical renal disease. Sonography of the kidneys revealed: 1) bilateral echogenic (hyperechoic renal cortex) kidneys 2) both kidneys appear small in size (atrophic) 3) reduced thickness (thinning) of renal cortex (10mm.) 4) reduction in cortico-medullary differentiation 5) Color doppler imaging of the kidneys revealed reduced flow in both kidneys. These ultrasound images are diagnostic of chronic medical renal disease (or chronic renal failure). All ultrasound images above (taken using Toshiba Nemio-XG Color Doppler imaging system, by Joe Antony, MD, India.

Reference: http://emedicine.medscape.com/article/238798-diagnosis (free article).

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This page was last edited on: Saturday March 27, 2010 03:46 PM

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