Medullary sponge kidney on IVP


The intravenous pyelogram shows ectatic distal collecting ducts containing the microcalcifications, forming the bouquet of flowers appearance.  If you look closer there are also dilated contrast-filled tubules within the renal medulla which is known as the paintbrush appearance. These findings are characteristic for medullary sponge kidney (MSK) on an intravenous pyelogram.