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Bear with me – I am a first time poster…
12 year old F/S lab presented for ADR and was diagnosed with pancreatitis via spec CPL and ultrasound. rDVM says UA WNLs and no changes in renal enzymes
Left kidney – small hyperechoic shadowing foci in cortex that looks like normal “old dog” changes (calcification). (see attached video)
Right kidney – irregular contour, hyperechoic area in cortex that is non-shadowing that looks more like an infarct. (see attached video)
[videoembed id=6883]
Bear with me – I am a first time poster…
12 year old F/S lab presented for ADR and was diagnosed with pancreatitis via spec CPL and ultrasound. rDVM says UA WNLs and no changes in renal enzymes
Left kidney – small hyperechoic shadowing foci in cortex that looks like normal “old dog” changes (calcification). (see attached video)
Right kidney – irregular contour, hyperechoic area in cortex that is non-shadowing that looks more like an infarct. (see attached video)
[videoembed id=6883]My question – can the irregular contour and infarct-like lesion in the right kidney be “old dog changes” as well, or is that more likely to be due to disease?
Thanks
Jennifer
Comments
Hi Jennifer The right kidney
Hi Jennifer The right kidney has multiple infarcts and stones with ill defined areas of echogenic fat suggestive for inflammation. As stones move they obstruct and you get local inflammatory events and infarcts and resultant capsular retraction as the infarct remodels.
The left kidney is in good shape but a solid shadowing cortical stone in present in the caudal cortex but is stable. You never know when stones will move and cause a path of destruction along the way. You can get local cortical damage or overt hydronephrosis once they reach the pelvis and ureter and depending how long it takes to pass the hydro increase and once liberated of obstruction (if that occurs) the kidney recoils into some form of a raisin with varying degree of permanent damage.
Hi Jennifer The right kidney
Hi Jennifer The right kidney has multiple infarcts and stones with ill defined areas of echogenic fat suggestive for inflammation. As stones move they obstruct and you get local inflammatory events and infarcts and resultant capsular retraction as the infarct remodels.
The left kidney is in good shape but a solid shadowing cortical stone in present in the caudal cortex but is stable. You never know when stones will move and cause a path of destruction along the way. You can get local cortical damage or overt hydronephrosis once they reach the pelvis and ureter and depending how long it takes to pass the hydro increase and once liberated of obstruction (if that occurs) the kidney recoils into some form of a raisin with varying degree of permanent damage.
Here is a kidney (from the
Here is a kidney (from the pathology 400 CD -http://www.sonopath.com/products_cd_atlas.asp) with a pelvic stone, renal swelling and hyperechoic ill defined pericapsular fat owing to inflammation. The patient was very painful on imaging of this.
Here is a kidney (from the
Here is a kidney (from the pathology 400 CD -http://www.sonopath.com/products_cd_atlas.asp) with a pelvic stone, renal swelling and hyperechoic ill defined pericapsular fat owing to inflammation. The patient was very painful on imaging of this.
Here is another kidney form
Here is another kidney form the CD with pretty infarctions for an unknown reason as there were no stones but the other kidney was normal so would make sense if this kidney has an episode of pyelonephritis or vasculitis in the past and this is what was left over. the patient here was asymptomatic with normal urinalysis.
Here is another kidney form
Here is another kidney form the CD with pretty infarctions for an unknown reason as there were no stones but the other kidney was normal so would make sense if this kidney has an episode of pyelonephritis or vasculitis in the past and this is what was left over. the patient here was asymptomatic with normal urinalysis.
And a classic dystrophic cat
And a classic dystrophic cat kidney from the same CD with stones and infarctions and resultant infarcts. I see this more in cats than in dogs.
Bottom line is any time there is an infarction we know there was a vascular event whether from local vasculitis, from a clot shower as in a cat for some reason like cardiomyopathy, stone passage and local ischemia, infection like pyelonephritis…and so forth as you will see infarctions in all these cases but not always.
You dog looks like he has an acute on chronic stone induced nephritis and potential infection with secondary infarctions. The ill-defined echogenic fat suggests an acute phase.
Was he painful on imaging the right kidney?
And a classic dystrophic cat
And a classic dystrophic cat kidney from the same CD with stones and infarctions and resultant infarcts. I see this more in cats than in dogs.
Bottom line is any time there is an infarction we know there was a vascular event whether from local vasculitis, from a clot shower as in a cat for some reason like cardiomyopathy, stone passage and local ischemia, infection like pyelonephritis…and so forth as you will see infarctions in all these cases but not always.
You dog looks like he has an acute on chronic stone induced nephritis and potential infection with secondary infarctions. The ill-defined echogenic fat suggests an acute phase.
Was he painful on imaging the right kidney?
Thanks for the reply.
–
Thanks for the reply.
– Could the ill defined area of echogenic fat around the R kidney be related to the pancreatitis?
– The UA was clear except USG of 1.026 (not azotemic) although I know there can be quite a difference between UAs. I will tell rDVM to do culture to rule out infection.
– The dog was sedated with some torb/valium. She wasn’t really that painful. The only reaction I got was around the pancreas and a bit while I was digging for the right kidney in her very deep/fat belly. Interestingly enough, the only presenting complaint for this dog was “excessive panting”.
– So calculi vs. mineralization – I see how this is calculi, but how do you tell the difference between that and mineralization? Does it have to be more diffuse and part of collecting system? Less acoustic shadowing? A diagnosis of exclusion when no other renal disease is seen?
Thanks for all the guidance. I am really keen to learn everything ultrasound, but don’t really have any mentorship close to where I am, so this website rocks!
Thanks again!
Jennifer
Thanks for the reply.
–
Thanks for the reply.
– Could the ill defined area of echogenic fat around the R kidney be related to the pancreatitis?
– The UA was clear except USG of 1.026 (not azotemic) although I know there can be quite a difference between UAs. I will tell rDVM to do culture to rule out infection.
– The dog was sedated with some torb/valium. She wasn’t really that painful. The only reaction I got was around the pancreas and a bit while I was digging for the right kidney in her very deep/fat belly. Interestingly enough, the only presenting complaint for this dog was “excessive panting”.
– So calculi vs. mineralization – I see how this is calculi, but how do you tell the difference between that and mineralization? Does it have to be more diffuse and part of collecting system? Less acoustic shadowing? A diagnosis of exclusion when no other renal disease is seen?
Thanks for all the guidance. I am really keen to learn everything ultrasound, but don’t really have any mentorship close to where I am, so this website rocks!
Thanks again!
Jennifer
Hi Jennifer, Renal calculi
Hi Jennifer, Renal calculi posses a strongly reflective surface and display distal acoustic shadowing, depending on size of the calculus and frequency of the transducer. The calculi are located in diverticula , pelvis or proximal ureter. It may be difficult to differentiate calculi from parenchymal mineralization, however calculi are often associated with pelvic dilation and can be confidently diagnosed if they are surrounded by fluid or clearly visible in the pelvis.
Dont forget to use you power or color Doppler to distingish accurate arteries from mineralization since the accurate arteries can also have acoustic shadowing at the corticomedullary junction.
Hope this answers your question, let me know if you want or need a good article on kidney pathology via ultrasound, good article just came out in Fel med /surgery
Doug
drdougcasey@gmail.com
Hi Jennifer, Renal calculi
Hi Jennifer, Renal calculi posses a strongly reflective surface and display distal acoustic shadowing, depending on size of the calculus and frequency of the transducer. The calculi are located in diverticula , pelvis or proximal ureter. It may be difficult to differentiate calculi from parenchymal mineralization, however calculi are often associated with pelvic dilation and can be confidently diagnosed if they are surrounded by fluid or clearly visible in the pelvis.
Dont forget to use you power or color Doppler to distingish accurate arteries from mineralization since the accurate arteries can also have acoustic shadowing at the corticomedullary junction.
Hope this answers your question, let me know if you want or need a good article on kidney pathology via ultrasound, good article just came out in Fel med /surgery
Doug
drdougcasey@gmail.com
Glad to be of help Jennifer.
Glad to be of help Jennifer. The ill-defined hyperechoic area that is most interesting in the RK clip is in the 11 o”clock position that looks like it follows an infarct into the cortex. Inflamed fat can look the same no matter what organ its associated with. The ill-defined fuzzy hyperechoic fat in pancreatitis is the most common but will occur with any organ so you can see what the hyperechoic fuzzy fat is attached to and imagine that organ system is the problem. Happens often with transmural inflammation in the GI tract or aggressive infiltrative lymphoma in all organs.
Yeh we think Sonopath.com rocks too:)…but are always working to improve it and make it more user-friendly
Glad to be of help Jennifer.
Glad to be of help Jennifer. The ill-defined hyperechoic area that is most interesting in the RK clip is in the 11 o”clock position that looks like it follows an infarct into the cortex. Inflamed fat can look the same no matter what organ its associated with. The ill-defined fuzzy hyperechoic fat in pancreatitis is the most common but will occur with any organ so you can see what the hyperechoic fuzzy fat is attached to and imagine that organ system is the problem. Happens often with transmural inflammation in the GI tract or aggressive infiltrative lymphoma in all organs.
Yeh we think Sonopath.com rocks too:)…but are always working to improve it and make it more user-friendly