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38 IMAGING ESSENTIALS PEER REVIEWED ( Figure 8 ), where diffuse changes can be seen. The kidneys are usually enlarged, irregular, hyperechoic, with hypoechoic subcapsular thickening. 23 Diffuse Abnormalities of the Renal Parenchyma Ethylene Glycol Toxicosis Ethylene glycol toxicosis causes a severe increase in cortical and, to a lesser extent, medullary hyperechogenicity ( Table 1 ). In addition, there can be a medullary rim sign, which is denoted as a circumferential hyperechoic band located in the medulla, parallel to the corticomedullary junction ( Figure 9 ); this appearance is consistent with mineralization, necrosis, congestion, and/or hemorrhage. 20 FIGURE 6. Long axis sagittal image of the right kidney in a Rhodesian ridgeback. There is a large, lobulated, heterogeneous mass located in the cranial pole of the kidney. The margins of this mass are well demarcated (white arrowheads). More normal renal parenchyma can still be identified in the caudal pole of the kidney (white arrow). This mass was diagnosed as a renal cell carcinoma. FIGURE 7. Long axis sagittal image of the left kidney in a Labrador retriever. There is an expansile, well demarcated, lobulated, heterogeneously hyperechoic mass in the caudal pole of the kidney, causing distortion of the renal architecture and shape. This dog was diagnosed with renal cell carcinoma. FIGURE 8. (A) Long axis sagittal and (B) short axis transverse images of the right kidney in a domestic shorthaired cat. The cortex is thickened and hyperechoic, and its margin is irregular. Anechoic fluid is detected within the mildly to moderately distended renal pelvis (white arrowheads). A very small amount of anechoic to hypoechoic fluid surrounds the kidney (white arrow). This cat was diagnosed with renal lymphoma. A B FIGURE 9. Long axis sagittal image of the right kidney in a mixed-breed dog. The renal cortex is severely hyperechoic. There is also a hyperechoic band within the medulla traversing parallel to the corticomedullary junction (white arrows). This dog was diagnosed with ethylene glycol toxicosis.