Category: Genitourinary

Female teenager with left lower quadrant pain

CT of paraovarian cyst and ovarian cyst
Coronal (left) and axial (above left) CT with contrast of the abdomen shows a large, simple, fluid-filled structure above the bladder which is arising from the left ovary. Axial CT (below right) obtained more inferiorly shows a second, smaller, fluid-filled structure in the midline between the uterus and rectum which is in close association with the right ovary which is just to the right of the uterus.

The diagnosis was a large left ovarian cyst and a right paraovarian cyst.

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.