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Joseph Junewick, MD FACR
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Renal Medullary Ischemia

Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: US
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11 day old premature infant with oliguria.

Case Images


Renal Medullary Ischemia


US – Longitudinal and transverse emages of the right and left kidneys demonstrate heterogeneous increased echogenicity of the pyramids. There is a hypo-echoic band around the periphery of each pyramid and an anechoic central region extending down into the papilla.


Diminished renal function due to renal ischemia is not an uncommon occurrence in stressed neonates in intensive care units who have experienced hypoxic or ischemic events. Impaired renal perfusion may lead to abnormalities of the pyramids, cortex, or renal vasculature, which include changes such as acute tubular necrosis, medullary or cortical necrosis, and renal vein thrombosis. With hypoxic-ischemic events, the medullary pyrimids become heterogeneously hyperechoic and corticomedullary differentiation decreases.


Daneman A, Navarro OM, Somers GR et al. Renal Pyramids: Focused Sonography of Normal and Pathologic Processes. Radiographics 2010; 30(5):1287-1307.

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