Today's Veterinary Practice

NOV-DEC 2017

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37 NOVEMBER/DECEMBER 2017 ■ TVPJOURNAL.COM IMAGING ESSENTIALS Renal Abscess A renal abscess can occur in conjunction with fever and leukocytosis. Abscesses appear as poorly demarcated cavitary lesions that are irregular in contour with internal echoes and sedimentation, and they have variable degrees of distal acoustic enhancement ( Figure 3 ). Typically, the renal pelvis is enlarged. Renal Infarctions Ultrasonographically, organized infarcts are well-defined, wedge-shaped, cortical lesions located perpendicular to the capsule and extending centrally to the renal pelvis ( Figure 4 ). The base of the wedge-shaped lesion is directed toward the renal capsule while the apex points towards the hilus. They vary in appearance and, at the chronic phase, are typically hyperechoic and cause focal cortical depressions secondary to contracture and fibrosis. Renal Mineralization (Nephrocalcinosis) Renal mineralization can be seen in older dogs and cats. It is classified based on its location. Renal diverticular mineralization is caused by dystrophic mineralization. Renal parenchymal mineralization, however, is caused by mineralization of the renal cortex from deposition of calcium salts or other minerals (eg, ethylene glycol toxicosis). Mineralization is identified as hyperattenuating foci with distal acoustic shadowing within the renal diverticuli, pelvis, and/or cortex ( Figure 5 ); however, if there are punctate foci of hyperechogenicity, distal acoustic shadowing may not be evident. Renal Cystadenocarcinomas These tumors are commonly found in German shepherds and are associated with paraneoplastic nodular dermatofibrosis (neurofibromas). Ultrasonographically, one to several fluid-filled cavities (cysts) can be detected, and a solid tissue component can infiltrate the kidney and protrude into the cyst. 19 Other Renal Neoplasia Solid soft tissue masses may appear in a variety of ways: • Homogeneous or heterogeneous • Hypoechoic, isoechoic, or hyperechoic • Regular or irregular with variable margins ( Figure 6 ) • Altered renal internal architecture • Hypoechoic halo at the periphery of the cortex • Hyperechoic foci or striations throughout the medulla • Pyelectasia • Hypoechoic medullary or cortical nodules or masses 20 The differential diagnosis of hypoechoic nodules or masses includes lymphoma and malignant histiocytosis. 21 Other neoplasms that can affect kidneys include adenocarcinomas, hemangiomas, nephroblastomas, hemangiosarcomas, and metastases. 22 The most common renal tumor in the dog is renal cell carcinoma ( Figures 6 and 7 ). The most common renal tumor in the cat is renal lymphoma FIGURE 4. Long axis sagittal image of the left kidney in a domestic shorthaired cat. A focal, hyperechoic, wedge- shaped, focally concave, renal cortical infarction is seen extending from the cortex to the corticomedullary junction (white arrowheads) along the caudal pole of the kidney. FIGURE 5. Long axis sagittal image of the left kidney in a Siamese cat. Overall, the kidney is irregularly shaped, lobulated, and small. There is a large, hyperechoic, smoothly marginated nephrolith with distal acoustic shadowing located within a renal diverticulum (white arrow). Note the renal pelvis distended with anechoic fluid (white arrowhead).

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