Presentation
A denarian, female, clinically admitted with chronic glomerulonephritis, hypertensive heart disease, dilated cardiomyopathy, acute decompensated heart failure, difficulty in breathing and hypertension, for abdominal pelvic ultrasound evaluation.
Patient Data
The kidneys exhibit diffuse increase in their cortical parenchyma reflectivity with mild prominent and hypoechoic medullary pyramids suggesting underlying infective process. Cortical- medullary differentiation is relatively maintained bilaterally. The right kidney measures 6.4 x 2.9 cm while the left kidney measures 6.8 x 3.4 cm in size.
Color/power Doppler interrogation bilaterally shows paucity of the flow signals of the intra-renal vasculature more towards the cortical areas. Attempted pulsed Doppler interrogation bilaterally was sub-optimal due to the patient's difficulty in breathing with the only interlober waveforms quantified showing both arterial/venous waveform interference. Incidental bilateral pleural effusion (Right ~ 172 cc; Left ~ 345 cc) and mild ascites at the pelvic floor is noted. The urinary bladder is normal in capacity and wall outline and empties completely on voiding without retention.
Case Discussion
In the setting of hypoperfusion of the bilateral renal vascular tree plus diffusely increased reflectivity of the renal cortical parenchyma, pyelonephritides unequivocally ranks higher as the possible diagnosis and is likely acute in this presentation owing to the maintained sizes and the globularly preserved thickness of the renal cortices.