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 2016-04-24  Case of the week # 426  © Olga Ivanitskaya
Answer to the case of the week # 426
August 4, 2016 - August 18, 2016.

Olga Ivanitskaya
, MD ; Elena Andreeva, MD.
Moscow regions Research Institute of Obstetrics and Gynecology, Medical-Genetics Department, Moscow, Russia.

Following images illustrate two different cases of prenatally diagnosed anomaly.

Case report  Nº 1

A 32 year old woman (G2P1), with non-contributive history, was referred to our department due to fetal “renal cyst”. The patient’s first child was healthy. The first scan at 12 weeks was normal. 
During the second ultrasound examination at 21 week of pregnancy there was a giant “cyst” in the left kidney.

At 22 weeks of gestational age we found a semilunar anechogenic structure (56x20x26 mm in size) situated around the whole left kidney. Left renal pelvis was dilated (13 mm), but the left ureter was normal. 
The corticomedullary differentiation was absent and the parenchyma was thin and hyperechogenic without blood flow signal using color Doppler. 

The right kidney and urinary bladder were normal and so was the amount of the amniotic fluid. 
Right ureter was not dilated.  Both adrenal glands were intact. 

Diagnosis of left kidney urinoma was proposed. 
The parents decided to continue the pregnancy and diagno
sis was confirmed after birth.

Images 1 and 2: 2D and doppler images show anechogenic semilunar structure around the left kidney. Note the thin parenchyma and absence of color Doppler signal.


Case report  Nº 2

A 39 year old woman (G3P2), with unremarkable medical history, was referred to our department after her routine 19 weeks of pregnancy scan with the diagnosis of “retroperitoneal cyst”. Two patient’s children were healthy. The first scan at 12 weeks was normal. 

We revealed a male fetus corresponded to 20 weeks. Placenta and amniotic fluid volume was normal. 

The left kidney was enlarged (31 x 19 x 25mm) and displaced downwards because of anechogenic structure originated from its upper pole and located under the renal capsule. This structure was 16 mm in diameter. There was no pelvicaliceal dilation and the left ureter was normal 

In the right kidney area there was an oval anechogenic structure 36 mm in diameter. 
On its posterior surface there was a right kidney decreased in size (17 x 9 x 20mm) and displaced like a “half-moon”. The right ureter was not dilated.

Image 3
: 2D image of the left fetal kidney shows an anechogenic structure in the upper pole.

Image 4: 2D image of the right fetal kidney area with displaced kidney and the urinary bladder.

Parenchyma of the both kidneys was hyperechogenic, with obscure corticomedullary differentiation. The both adrenal glands were intact. Urinary bladder was dilated (20 mm) and didn’t empty during the whole time of examination. 

Image 5: 2D image shows dilated bladder with thick walls.

Diagnosis of urinoma of the both kidneys was determined. 
The parents opted for termination of the pregnancy and the autopsy confirmed the diagnosis. 

Congratulations to Javier Cortejoso for his brilliant answer!

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