Medullary nephrocalcinosis and renal calculi
26 years-old female with right pain that tends to radiate to the flank and lumbar areas.
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Increased echogenicity of the pyramid and renal calculus in the right kidney (Portuguese: "Rim Direito").
Ultrasound demonstrates a large upper pole echogenic focus with posterior acoustic shadowing consistent with a renal calculus. The pyramids are diffusely echogenic, but without shadowing, consistent with medullary nephrocalcinosis.
Although nephrocalcinosis may eventually progress to involve most of the pyramid, acoustic shadowing is rarely seen even in this situation.
Acoustic shadowing may be appreciated only in rare cases of extreme involvement of the pyramids or if there is development of associated calculi in the adjacent calices, like in this case.