Presentation
Three days of anuria.
Patient Data
Age: 1 year
Gender: Male
From the case:
Renal fungal balls
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Heteroechoic lesions (predominantly hypoechoic with echogenic areas within) filling the dilated pelvicalyceal system. A possible diagnosis is of fungal balls obstructing the pelvicalyceal systems bilaterally.
Case Discussion
Given the age of the patient and ultrasound appearance of obstructing primarily hypoechoic masses bilaterally, a possible diagnosis of bilateral fungal balls was proposed. However there is a broad differential diagnosis, including:
- non-fungal pyogenic or inflammatory debris
- blood clot
- tumor (e.g. transitional cell carcinoma)
- sloughed papilla
In this patient, the urine culture revealed a growth of Candida spp. which strongly supports a diagnosis of fungal balls. This possibility has to be considered in lesions filling the pelvicalyceal system in infants and immunosuppressed patients.
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