Pitfalls in Kidney Ultrasonography: Rare Diseases

Abstract

Ultrasonography (US) is well known to improve the quality of the clinical diagnosis due to its rapidity, repeatability and non-invasivity. While the physician is accustomed to frequent diseases, rare conditions may not be recognized. Our aim is to describe US images in rare kidney diseases and discuss some diagnostic implications in the detection of these pathologies. We analyzed the morphological US aspects in patients from the Nephrology Department of the Mureş County Clinical Hospital during a period of ten years. We performed a routine abdominal US for all cases. The examination was made with various US devices. The final positive diagnosis was made by clinical or other imaging modalities. We found 19 patients (0.095% of the total investigations) with specific clinical presentations and suggestive US imaging for rare renal diseases: 6 cases with medullary sponge kidney, 2 with persistence of fetal lobulation, 2 cases with hydatid cyst, 2 HIV associated nephropathies, one post-biopsy arterio-venous fistula, 2 cases with tuberous sclerosis complex, one case with superior renal artery branch stenosis, one rare mixed urothelial and sarcomatous tumor and two rare images in renal tuberculosis. For each case we described the US appearance and discussed the pitfalls that may lead to misdiagnosis. US is an important investigation in urology and nephrology. Being aware of rare diseases or rare US images is important in order to establish the final positive diagnosis and avoid unnecessary invasive and expensive procedures.