Sonopath Forum

Hematuria

Kirby is a 10 year old Lab with a history of hematuria. Per owner no history of dysuria/poilakuria.

Last Urinalysis had no blood and the urine culture was negative.

I did an ultrasound on Kirby and could find no lesions in the bladder or prostate.

I did think there was some shadowing in the L kidney- maybe a stone producer?

No history of pain that might account for stone movement.

I am posting 2 cines of the kidneys and a .jpg of the prostate. No images of the bladder- looked totaly normal.

Any feedback would be appreciated.

Kirby is a 10 year old Lab with a history of hematuria. Per owner no history of dysuria/poilakuria.

Last Urinalysis had no blood and the urine culture was negative.

I did an ultrasound on Kirby and could find no lesions in the bladder or prostate.

I did think there was some shadowing in the L kidney- maybe a stone producer?

No history of pain that might account for stone movement.

I am posting 2 cines of the kidneys and a .jpg of the prostate. No images of the bladder- looked totaly normal.

Any feedback would be appreciated.

Comments

rlobetti

July 6, 2018 at 9:06 am -

Renal stone is most likley

Renal stone is most likley incidental. With the hematuria and normal bladder/prostate and no hematuria on urinalysis, would think of lower urethra/prepuce etiology. May require contrast urethrogram and if available urethroscopy.

randyhermandvm

July 6, 2018 at 12:28 pm -

Thanks Remo

Thanks Remo

bhylands77

July 10, 2018 at 5:26 pm -

You have eveidence of mild

You have eveidence of mild pyelectasia on the second video. Now you need to look at why. I think that you need to examine the renal crest and it’s associated pelvis in greater detail. This is easiest in a transverse plane.Look for thickening of the wall of the proximal ureter . Also look for signs of double layering. Look to see how echogenic the fluid is in the renal pelvis if you can image it. You will need to zoom in to look at it better. Examine the crest to see if it is hyperechoic either in general or in focal diffuse patches. You may also want to measure an RI value. These are some observations that might help you identify an underlying pyelonephritis.

randyhermandvm

July 11, 2018 at 8:56 pm -

Thanks bhylands77.
Can you

Thanks bhylands77.

Can you post some images of the changes you describe. You sort of lost me at pyelectasia 🙂

bhylands77

July 12, 2018 at 1:39 am -

Here is an example of the

Here is an example of the renal crest showing a flare from a case of pyelonephritis. The second view shows how regional it can be.

bhylands77

July 12, 2018 at 1:49 am -

The other image is that of a

The other image is that of a zoomed view of the renal crest and proximal ureter. This is where you look for distinct double layering as seen with direct inflammation associated with an ascending infection.

randyhermandvm

July 12, 2018 at 10:46 pm -

Thanks for the images.

Thanks for the images. Clarifies what you were saying.

July 13, 2018 at 11:13 am -

NICE BOB THANK YOU… I ALSO

NICE BOB THANK YOU… I ALSO GUESTIMATE INFECTION WHEN THE FLUID IS ECHOGENIC AND THE RENAL PELVIC FAT IS ILL-DEFINED. sorry for the caps:)

Pyelectasia can come from scarring as well as its common in stone movers so its important to take bobs comments along with everything else clinically becasue you can push abs for 6 weeks to tx pyelonephritis when the pyelectasia may be left over from scarring or fullness from moving stones historically and no infection… ive seen this with pyelocentesis of clean urine in pyelectasia cases. Aside from US guided pyelocentesis with a big enough dilation its educated guesswork often in these cases without a pelvic sample.