Dx: The Abnormal-Appearing Kidney
Your biliary scan demonstrates a normal gallbladder and normal portal triad with no gallstones, sludge, wall thickening, pericholecystic fluid, or other abnormal findings. The other ultrasound image shows a very abnormal appearing right kidney. On the scan, you can see the superior two-thirds of the right kidney and the bottom portion of the liver. The whiter (hyperechoic) area between them is perinephric fat. Bedside emergency renal ultrasounds are typically performed to evaluate for hydronephrosis. On this patient’s scan, you don’t see any evidence of hydronephrosis. However, the normal distinction between the hyperechoic renal pelvis and the more hypoechoic medulla and cortex is not visible either. The whole kidney looks abnormally homogenous. The discerning eye will also note that it appears both enlarged and “lumpier” than normal. Compare the abnormal kidney to the ultrasound image of a normal kidney below.
Unfortunately your patient ends up being diagnosed with renal cell carcinoma with metastases. This was not the type of break in the monotony that you were hoping for. As you explain the test results to her, the patient thanks you for your help. Although she is saddened by the test results, at least now she has a diagnosis and she can move forward with treatment options.
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