PEDIATRIC RADIOLOGY: Genitourinary Radiology
Case Author: Krista L. Birkemeyer, MD, Cincinnati Children’s Hospital Medical Center
History
2-day-old boy (born at 37 weeks’ gestation) with hematuria and hypertension; ultrasound has been performed, and the next imaging study must be determined.
Imaging Findings
Longitudinal gray-scale ultrasound image of the right kidney (A) shows abnormally increased parenchymal echogenicity, decreased corticomedullary differentiation, and irregular contour of the medullary pyramids (straight arrows). A small hypoechoic focus is present in the cortex (curved arrow). Longitudinal gray-scale ultrasound image of the right kidney (B) shows subtle linear echogenic perivascular streaks (arrows). The right kidney is enlarged and has a globular shape.
Diagnosis
Color Doppler ultrasound
Teaching Points
When renal vein thrombosis is clinically suspected, management includes Doppler ultrasound to confirm the diagnosis and document extent of thrombus, clinical evaluation for a prothrombotic state, and anticoagulation and/or fibrinolytic therapy. Color Doppler ultrasound may show segmental or diffuse perfusion abnormalities or venous thrombosis, but thrombosis can be intrarenal and thrombus in the main renal vein is not a requisite for diagnosis.
Contrast-enhanced CT and MRI are not typically used to assess renal vein thrombosis but can be useful if the sonographic findings suggest a mass lesion.
Renal venography was the study of choice for renal vein thrombosis but has been replaced by Doppler ultrasound because the latter is available, noninvasive, portable, and sensitive.
Suggested Readings
Brandão LR, Simpson EA, Lau KK. Neonatal renal vein thrombosis. Semin Fetal Neonatal Med 2011; 16:232–328
Elsaify, WM. Neonatal renal vein thrombosis: grey-scale and Doppler ultrasonic features. Abdom Imaging 2009; 34:413–418
This page is updated with new content weekly. It was last updated on June 25, 2018.