Pseudokidney sign (hepatic flexure)

Case contributed by Dr Prat-Matifoll

Presentation

75 year-old patient refers acute abdominal pain in the right upper quadrant. Previous medical history showed an important loss of weight in 5 months.

Patient Data

Age: 75
Gender: Female
Ultrasound

This image shows a typical pseudokidney sign: Note the marked bowel wall thickening which apposes mucosal surfaces giving a central echogenic stripe as a result. 
This finding is non-specific and the differential diagnosis includes carcinoma, lymphoma, inflammatory colitis, intussusception and necrotizing enterocolitis, among others.

An increased Doppler flow within the lesion was observed in our case.

Annotated image

Pseudokidney sign:

  • echogenic stripe (red arrows): mucosal surfaces seen apposed together in the center
  • pseudokidney morphology (yellow arrows): note the hypoechoic thickened colonic wall (hepatic flexure)

In our case, extraluminal air was observed (blue arrow): note the dirty shadow below the hyperechogenic line.

An enhanced CT was performed showing an irregular colonic wall thickening associated to multiple adenopathies and misty mesenterium. Note the presence of extraluminal air adjacent to the lesion.

Case Discussion

Colonoscopy and biopsy confirmed the presence of an underlying adenocarcinoma.

Pseudokidney sign is a non-specific sign which could be observed when there is a bowel wall thickening which apposes mucosal surfaces giving an echogenic stripe. The differential diagnosis includes carcinoma, lymphoma, inflammatory colitis and necrotizing enterocolitis, among others. In some cases, this sign could be observed in other entities such as intussusception, with a hyperechoic mesenterium in the center of the pseudokidney. A pathological lesion is found behind pseudokidney pattern in most of cases. 

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Case information

rID: 31287
Case created: 29th Sep 2014
Last edited: 6th Apr 2016
Inclusion in quiz mode: Included

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