Hemorrhagic Necrosis of the Right Uterine Tube and Ovary
Joseph Junewick, MD FACR
over 5 years ago
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Heather Borders, MD
|Diagnostic Category: Infectious-Inflammatory
|Created: over 6 years ago
|Updated: over 6 years ago
15 year old female with multiorgan involvement of SLE with overlap with MCT disease. Dermopathy, hepatitis, pancreatitis, nephropathy, coagulopathy, pancytopenia, myositis. Received pulse of solumedrol. Serum creatinine is 1.28 mg/dl. Protein/creatinine ratio is 1.7. C3 is 47, C4 is 15 and CH50 is 31. RF is 497 U/ml (normal is less than 25). Cardiolipin negative. ESR is 83. CRP is 26.4. Positive ANA, and RF. DNA pending.
Lupus nephritis, biopsy compatible with grade I mesangial lupus nephritis.
US-Echogenic cortex with peripheral hypoechoic rim and loss of corticomedullary differentiation.
CT-Heterogeneous, enlarged kidneys with rim of normal density tissue and a few wedge shaped areas of low density.
CT head-Multiple punctate parotid calcifications.
The hypoechoic cortical rim is reported in lupus nephritis, possibly due to cortical interstitial edema. Differential includes cortical necrosis, cystic renal disease.
Additionally, a pattern of multifocal round or wedge shaped cortical foci of decreased echogenicity is reported, likely due to vasculitis and active interstitial inflammation. Differential for this pattern is pyelonephritis, infarcts or neoplasm.
Ultrasound images in this patient show the hypoechoic cortical rim. Focal areas of decreased echogenicity were not identified on ultrasound. However, the CT demonstrated focal areas of decreased density, likely due to infarct and vasculitis.
Journal of Ultrasound in Medicine, Vol 6, Issue 2 75-79, American Institute of Ultrasound in Medicine
The hypo-echoic cortical rim in lupus nephritis
S P SLATER MB, ChB, C A HELLER FRCR, R S NANRA FRCP,
W S JONES ARMIT, DMU
Australasian Radiology Volume 38, Issue 1, pages 46–47, February 1994