Echogenic medullary pyramids
Fetal pyelectasis on prenatal ultrasound and questionable dehydration
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Left fetal kidney with echogenic renal medullary pyramids identified by a "red, blue, white" sign (artery, vein, pyramid), visible on longitudinal and transverse views.
Echogenic renal medullary pyramids in this neonate may be the result of Tamm-Horsfall protein deposition from dehydration or from transient, physiologic hyperechogenicity of the renal pyramids in neonates. There is maximal hyperechogenicity at the apex with a decreasing gradient toward the base of the pyramid. There is also a readily identifiable "red, blue, white" sign on ultrasound. This finding is not indicative of intrinsic renal disease, and will subside without intervention if physiologic, or with rehydration if due to hypernatremic dehydration. However, it can also be due to a number of other concerning differentials.
This case was submitted with supervision and input from:
Soni C Chawla, MD
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
- 1. Daneman A, Navarro OM, Somers GR. Renal Pyramids: Focused Sonography of Normal and Pathologic Processes. RadioGraphics 2010; 30:1287–1307. 10.1148/rg.305095222.
- 2. Ali UC, Sengupta K, Andankar P. Reversible renal medullary hyperechogenicitiy in neonatal hypernatremic dehydration. Pediatr Nephrol 2004: 19(9): 1050-2. DOI: 10.1007/s00467-004-1510-4