Hosting 718 files, 2916 images, and 4 contributors.

 
Random Case

Hyperextension Distraction Injury of Thoracic Spine
Joseph Junewick, MD FACR
over 5 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Papillary Necrosis

Case Detail

Anatomy: Genitourinary
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 5 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
Adobe32 PDF Imagej32 ImageJA

History

Premature infant with anuria.


Case Images


Diagnosis

Papillary Necrosis

Findings

US – Serial renal sonography (dates annotated on images). 5/2 Increased renal echogenicity with poor corticomedullary differentiation. 5/19 Continued abnormal renal echogenicity with improving corticomedullary differentiation. 5/27 Echogenic detached papillae; one sloughed papilla is obstructing the UPJ.

Discussion

The renal artery branches to form segmental arteries that further divide into lobar, interlobar and then arcuate arteries. The arcuate arteries parallel the corticomedullary junction and give rise to interlobar which contribute to the afferent arterioles of the glomerulus. Blood leaves the glomerular capillary network by efferent arterioles to form a secondary capillary network around the urinary tubules in the cortex or descend into the renal medulla as vasa recta. The vasa recta taper as they continue distally toward the apex, slowing flow and contributing to relative hypoxia. Further, the hypertonic environment predisposes this region to injury. Renal papillary necrosis is the consequence of ischemia. Inflammation or trauma can lead to edema of the interstitium and compression of the medullary vasculature. Hypotension (dehydration, sepsis, vascular catheter) can also contribute to papillary necrosis. Renal papillary necrosis is seen in diabetes, analgesic use, hemoglobinopathies (sickle cell disease), pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive uropathy.

Reference

Jung DC, Kim SH, Jung S, et al. Renal Papillary Necrosis: Review and Comparison of Findings at Multi–Detector Row CT and Intravenous Urography. 2006 RadioGraphics (2006); 26: 1827-1836.



Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare