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Retroperitoneum » Kidneys, Ureters
Medullary nephrocalcinosis
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Presentation A 39 year old woman with a history of renal disease presented for ultrasound. She complains of intermittent bilateral flank pain for two days.
 
 
 
Caption: Sagittal scan of the right lumbar region
Description: The right kidney is normal in size, but exhibits increased echogenicity of the medullary pyramids. No obvious acoustic shadowing is noted from the echogenic foci.
 
 
 
Caption: Transverse image of the right kidney
Description: The transverse plane also demonstrates increased echogenicity of the medullary pyramids.
 
 
 
Caption: Oblique sagittal scan of the left kidney
Description: The left kidney also appears normal in size. This plane near the margin of the kidney better demonstrates the increased echogenicity of the medullary pyramids.
 
 
 
Caption: Sagittal left kidney
Description: The highly echogenic medullary pyramids are again noted. The hyperechoic areas do not cause acoustic shadowing.
 
Differential Diagnosis Medullary nephrocalcinosis
 
Final Diagnosis Medullary nephrocalcinosis. This is consistent with the patient`s known diagnosis of medullary sponge kidney.
 
Discussion Medullary nephrocalcinosis and medullary sponge kidney have been discussed in another case [click here to view]

The case presented here illustrates a common ultrasound finding of medullary nephrocalcinosis - echogenic medullary pyramids with no posterior acoustic shadowing.
 
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