Presentation
Work up for hematuria.
Patient Data
Age: 20 years
Gender: Female
From the case:
Paintbrush sign - Intravenous urography
{"study":{"id":122664,"case_slug":"paintbrush-sign-intravenous-urography","modality":"Fluoroscopy","series":[{"id":58845055,"content_type":"image/jpeg","frames":[{"id":58845055,"width":2224,"height":3012,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845056,"content_type":"image/jpeg","frames":[{"id":58845056,"width":2404,"height":1792,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845057,"content_type":"image/jpeg","frames":[{"id":58845057,"width":2344,"height":2748,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845058,"content_type":"image/jpeg","frames":[{"id":58845058,"width":2404,"height":2908,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845059,"content_type":"image/jpeg","frames":[{"id":58845059,"width":2360,"height":2996,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":59081649,"content_type":"image/png","frames":[{"id":59081649,"width":1529,"height":1655,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_tiny.jpeg","jumbo":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_jumbo.jpeg","small":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_small.jpeg","thumb":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_thumb.jpeg","medium":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_medium.jpeg","gallery":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_gallery.jpeg","big_gallery":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d_big_gallery.jpeg","original":"5cc1a02179703e0f05f004c20cff9432c90efa73b79e3e5f8f0ce7582a1dcb2d.png"}]},"perspective":"Frontal - zoomed","specifics":""},{"id":58845060,"content_type":"image/jpeg","frames":[{"id":58845060,"width":2412,"height":2828,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":59081648,"content_type":"image/png","frames":[{"id":59081648,"width":596,"height":641,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_tiny.jpeg","jumbo":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_jumbo.jpeg","small":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_small.jpeg","thumb":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_thumb.jpeg","medium":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_medium.jpeg","gallery":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_gallery.jpeg","big_gallery":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b_big_gallery.jpeg","original":"370eae62ee14341e2ecf065e69c34f30eb1199ac92367fe4d7ae246774bd4c0b.png"}]},"perspective":"Frontal - zoomed","specifics":null},{"id":58845061,"content_type":"image/jpeg","frames":[{"id":58845061,"width":2308,"height":2816,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845062,"content_type":"image/jpeg","frames":[{"id":58845062,"width":2400,"height":1680,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null},{"id":58845063,"content_type":"image/jpeg","frames":[{"id":58845063,"width":2448,"height":1864,"current":true}],"annotations":[],"encodings":{"original_dicom":null,"video":null,"thumbnailed_files":[{"tiny":"0._tiny.jpeg","jumbo":"0._jumbo.jpeg","small":"0._small.jpeg","thumb":"0._thumb.jpeg","medium":"0._medium.jpeg","gallery":"0._gallery.jpeg","big_gallery":"0._big_gallery.jpeg","original":"0..jpg"}]},"perspective":"Frontal","specifics":null}],"caption":{"us":null,"gb":null},"findings":{"us":"","gb":""},"contributor_login":"dr mt niknejad","case_id":147246,"case_key_image_id":59081648,"case_featured_at":null},"current_user":null,"access":{"can_edit":false,"can_download":true,"can_feature":false,"can_pin":true}}
In a non-contrast image, no nephrolithiasis or renal parenchymal calcification could be identified. After contrast media administration, exaggerated stranded enhancement of the medullary pyramids is evident bilaterally, better seen on the zoomed images, resembling a paintbrush sign.
Case Discussion
A paintbrush sign on IVU or CT-IVU describes the streaky appearances of dilated contrast filled tubules within the renal medulla, suggesting medullary sponge kidneys or renal tubular ectasia (which the patient was confirmed to have).