Category: Genitourinary

Toddler with a left-sided abdominal mass

US and CT of adrenal neuroblastoma
Sagittal US of the left kidney (above left) shows a large, solid, hyperechoic mass superior to the left kidney. Axial CT with contrast of the abdomen (above right) shows an ill-defined solid mass in the region of the left adrenal gland, which (below right) crosses the midline and encases the mesenteric vasculature. Axial CT without contrast of the brain (below left) shows a lytic lesion in the right mandible.

The diagnosis was neuroblastoma arising from the left adrenal gland with metastases to the skull.

Newborn with a cystic kidney on prenatal ultrasound

US of multicystic dysplastic kidney
Sagittal US of the right kidney (above) shows it to contain multiple cysts of various sizes that do not communicate. There is also a paucity of renal parenchyma. Sagittal US of the right kidney 1 month later (below) again shows multiple cysts of various sizes that do not communicate and interval decrease in the amount of renal parenchyma present.

The diagnosis was multicystic dysplastic kidney.

Teenager playing ice hockey who was hit hard by another player into the boards

CT of perirenal hematoma in a patient with a ureteropelvic junction obstruction
Axial CT without contrast of the abdomen (above) shows the unenhanced right kidney to have a low density dilated central collecting system and to be surrounded by a high density cresenteric fluid collection in the right perirenal space. Axial CT with contrast (below) better shows the low density dilated central collecting system and a decreased amount of enhancement in the right kidney when compared to the normal left kidney. The amount of enhancement in the right kidney is the same density as the right perirenal fluid collection.

The diagnosis was a right perirenal hematoma in a patient with right ureteropelvic junction obstruction.

Female school ager with abdominal distension

US and MRI of ovarian endodermal sinus tumor
AXR (above left) shows displacement of the bowel loops to the left upper quadrant. Sagittal US of the abdomen (above right) shows a large solid heterogenous intraperitoneal mass in the lower right abdomen whose organ of origin was uncertain. There was a large amount of ascites. Coronal (below left) and sagittal (below right) T1 MRI with contrast of the abdomen shows a large right-sided mass that was oval in shape with smooth contour with multiple cystic lobulations with enhancing septae within it superiorly with it being more solid inferiorly and which appeared to be adherent to the right ovary.

The diagnosis was ovarian endodermal sinus tumor.

Male toddler with a swollen right scrotum after having been taken cross country skiing in their parents baby backpack

US of testicular hematocele
Transverse US of the scrotum (above) shows the right scrotum to be larger in size than the left scrotum. Transverse (below left) and sagittal (below right) US of the right scrotum shows the right testicle to be intact, however it is surrounded by a complex septated fluid collection.

The diagnosis was testicular hematocele.

Teenager with right flank pain when drinking large amounts of soda pop

IVP of retrocaval ureter
AP image from the excretory phase of a vintage intravenous pyelogram (left) shows a normal left renal collecting system and left ureter and an extremely dilated right renal collecting system. Magnified views of the right ureteropelvic junction (right above and right below) show a sharp kink at the right ureteropelvic junction.

The diagnosis was retrocaval ureter causing right ureteropelvic junction obstruction.

Female infant with a purple mass protruding from her vagina

US and IVP of prolapsed ectopic ureterocele
Sagittal US of the vaginal mass (above left) shows it to be cystic in nature. Sagittal US of the right kidney (middle left) shows moderate hydronephrosis of the upper and lower poles of a duplicated renal collecting system. Sagittal US of the left kidney (below left) shows marked hydronephrosis of the upper pole and moderate hydronephrosis of the lower pole of a duplicated renal collecting system. Excretory phase of a vintage intravenous pyelogram (right) shows on the right a moderately hydronephrotic duplicated renal collecting system and on the left an obstructed nonopacified nonfunctional upper pole collecting system which displaces the opacified functional moderately hydronephrotic lower pole collecting system inferolaterally (drooping lily sign).

The diagnosis was prolapsed ectopic ureterocele from the upper pole of the left kidney in a patient with bilateral duplicated kidneys.

Preschooler with a palpable midline abdominal mass

AXR and US and CT of rhabdomyosarcoma of the bladder
AXR (above left) shows a soft tissue mass in the mid abdomen displacing the bowel loops superiorly. Transverse and sagittal US of the mass (below left) show a solid, homogenous, lobulated mass. Axial CT with contrast of the abdomen (below right) shows a large heterogeneous mass in the mid to left abdomen with a low density center and swirling enhancement. There was a suggestion of direct tumor invasion into the right rectus muscle anteriorly (above right) and the bladder inferiorly.

The diagnosis was rhabdomyosarcoma arising from the dome of the bladder.

Toddler with moderate to marked right hydronephrosis on ultrasound

IVP of ureteropelvic junction obstruction due to a crossing vessel
AP image from the excretory phase of an intravenous pyelogram (above) shows a normal left renal collecting system and a markedly dilated right renal collecting system. No contrast was seen in the right ureter. AP image from a retrograde pyelogram (below) shows a markedly dilated right renal collecting system and a narrowing and tortuosity to the proximal right ureter.

The diagnosis was right ureteropelvic junction obstruction due to a crossing vessel.

Newborn with hypoplastic abdominal wall musculature

US and VCUG of prune belly syndrome
Sagittal US of the right (above left) and left (above right) kidneys shows them to be small in size and echogenic in appearance and to be hydronephrotic. US of the right ureter (below left) showed it to be extremely dilated and to be similar in appearance to the left ureter (not provided). Oblique view of the bladder during the voiding phase of a voiding cystourethrogram (below right) shows a large capacity bladder, a normal appearing urethra, and grade I vesicoureteral reflux.

The diagnosis was prune belly syndrome.

Toddler with a right-sided abdominal mass

MRI of Wilms tumor
AXR (above left) shows displacement of the bowel out of the right side of the abdomen. Sagittal US of the right kidney (above right) shows a large right renal mass that spares the upper pole of the right kidney. Coronal T1 MRI with contrast of the abdomen (below left) shows a large mass that is heterogenous in appearance that arises from the lower pole of the right kidney and that is demonstrating a claw sign superiorly. Axial T2 MRI (below right) again shows the heterogenous nature of the mass due to hemorrhage and necrosis.

The diagnosis was Wilms tumor.

Teenager after a motor vehicle accident

CT of ovarian cyst
Axial CT with contrast of the pelvis shows a distended contrast-filled bladder in the center of the image and contrast in the distal left ureter adjacent to the normal left ovary and contrast in the distal right ureter adjacent to the right ovary which contains a round low density lesion in its center. There is also a small amount of physiologic free fluid in the pelvis

The diagnosis was right ovarian cyst.

Infant with urinary tract infection

VCUG of an everting ectopic ureterocele
Sagittal US of the right (above left) and left (above right) kidneys shows parenchymal bars of tissue between the upper and lower poles of each kidney. Transverse US of the bladder (middle left) shows a round cystic structure on the right side of the bladder. Sagittal US of the bladder (middle right) shows the right ureter in continuity with the cystic structure within the bladder. AP image of the bladder (below left) obtained at the start of filling the bladder during a voiding cystourethrogram (VCUG) shows a round filling defect in the right base of the bladder. AP image of the bladder (below right) obtained during the voiding phase of the VCUG shows the previously seen filling defect in the base of the bladder has everted out of the bladder and now appears as a contrast filled structure to the right of the bladder.

The diagnosis was bilaterally duplicated kidneys with a right everting ectopic ureterocele.