MyPACS.net: Radiology Teaching Files > Case 367803

never visited MULTIFOCAL PYELONEPHRITIS AND TORSED RIGHT OVARY
Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: 10 month old female
History: 10 month old female with Donohue syndrome less than 1 week post-op G-tube placement. Patient has urinary tract infection and ultrasound is requested to evaluate for pyelonephritis.
Images:[small]larger

Fig. 1: Left kidney sag shows multiple wedge shaped echogenic areas in large kidney

Fig. 2: Left kidney sag power doppler shows perfusion defects

Fig. 3: Right kidney sag shows multiple wedge shaped echogenic areas

Fig. 4: Right kidney sag power doppler shows perfusion defects

Fig. 5: Right kidney trans shows wedge shaped echogenic area on right compatible with a focus of pyelonephritis

Fig. 6: Left ovary sag. The enlargment and multiple prominent follicles are abnormal for age and related to the patient's syndrome.

Fig. 7: Left ovary trans

Fig. 8: Right ovary sag

Fig. 9: Right ovary sag

Fig. 10: Right ovary sag doppler shows lack of perfusion.

Fig. 11: midline pelvis trans shows that both ovaries and large amount stool completely fill lower abdomen/pelvis

Fig. 12: midline pelvis trans
Findings:

Renal ultrasound: Scattered wedge shaped echogenic areas and perfusion defects in both kidneys. Right kidney measures 7.7 cm and is 100th percentile for volume. Left kidney measure 6.8 cm and is 83rd percentile for volume.

Pelvic ultrasound: Bilateral enlarged ovaries (associated with syndrome). Left ovary has innumerable follicles and good perfusion on doppler. Left ovary is stable in size since exam several months earlier. Right ovary looked like left ovary on prior exam. Right ovary is now twice as large since prior study with increased echogenic elements and very few cysts, compared to nearly entirely cysts previously. Right ovary is avascular by doppler.

Left ovary measures 3.7 cm with volume of 9 cc. Right ovary measures 4.8 cm with volume of 17 cc. Normal ovarian volume at this age is usually less than 1 cc.

Diagnosis:

Renal ultrasound: Bilateral multifocal pyelonephritis
Pelvic ultrasound: Right ovarian torsion. The large ovaries with multiple cysts/follicles would place patient at much higher risk for ovarian torsion.

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Additional Details:

Case Number: 367803Last Updated: 05-11-2004
Anatomy: Genitourinary (GU)   Pathology: Vascular
Modality: USExam Date: 02-26-2004Access Level: Readable by all users
Keywords: donohue syndrome, pyelonephritis, ovarian torsion

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