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1、RenalMassesRobertD.ThomasMDPediatricRadiologyRenalMassesBallsCystHematomaAbscessTumorDromedaryhumpBeansDuplication/anomalyCompensatoryhypertrophyHydronephrosisPyelonephritis/edemaHematomaPCKDTumorVascularocclusion/traumaRenalMassesbyAgeNewbornHydrone
2、phrosisMCDKAR-PCKDAnomaliesTumorsMesoblasticnephromaNephroblastomatosisChildhoodCystsHydronephrosis,MCDKAnomaliesHematomaTumorsWilmsLymphomaAngiomyolipomasHydronephrosis (Bean)Calyceal/PelvicobstructionCongenital(intrinsic/extrinsic)TBTumorUreterPhys
3、iologic(fullbladder)Congenital(1megaureter,ectopicureter,retrocaval)Inflammatory(TB,Crohn,PID,etc)Intraluminal(stone,clot,tumor,stricture)CongenitalUPJobstruction#1causeofrenalmassinnewbornAssociationsIpsilateralrefluxLowermoietyofduplicationMostcomm
4、oncauseofobstructionwithhorseshoekidneyCausesStricture,disorderedperistalsis,ischemia,redundanturothelium,crossingvessel,etc.CongenitalUPJobstructionImaging:MassinplainfilmsUS–dilatedpelvo-calycealsystem(communicatingcysts):dilatation-fluidequaltocor
5、ticalthicknessNM–obstructivepatternw/olasixresponsePitfallsUSmayunderestimatehydroduetooliguria/dehydrationinnewbornMCDKmaylooklikeUPJifonlyacouplecystspresentCongenitalUPJobstructionWork-upVCUG:co-existantipsilateralreflux*,urethralobstruction,contr
6、alateralrefluxScintigraphy:siteofobstruction&renalfunction*obstructiontorefluxatUPJ,dilutionofcontrastindilatedrenalpelvis,delayindrainagefromrenalpelvisMulticysticDysplasticKidney BeanorBallNotatrue“cysticdisease”etiologyissevereembryonicobstruction
7、duringmetanephricstageofdevelopmentSo…it’sanobstructionHallmark:non-functionofthekidneyBilateralitynotcompatiblewithlifeduetoseverepulmonaryhypoplasiaMulticysticDysplasticKidney2ndmostcommonrenalmassinnewbornTypesPelvoinfundibular–atresiasatureter,pe
8、lvis,infundibulaeMostcommon,grape-likecollectionofcystsanddysplasticglomeruli,atrophiedtubulesHydronephrotic-atresiaofproximalureteraloneUncommon(5%)MulticysticDysplasticKidneyImagingUS-IsolatedcystswithoutadefinablepelvisandwithoutnormalrenaltissueI
