36-year-old female with acute kidney injury, evaluate for hydronephrosis. RIGHT KIDNEY: Measures 13.3 cm in length. There is marked multifocal dilation of the renal calyces and infundibula, without dilation of the renal pelvis or ureter, progressively increased compared with prior studies. The cortex is markedly thinned with increased echogenicity. Additionally, there is now debris within these dilated calyces which has not been seen previously.LEFT KIDNEY: Measures 9.4 cm in length. Increased echogenicity without hydronephrosis. Left inferior pole 1.4 cm cyst without septation or solid component. URINARY BLADDER: Ileal conduit incompletely distended. OTHER: No significant abnormalities noted.
1. Marked right multifocal calyceal and infundibular dilation as described above. Dating back to 2005, this has been a progressive process and is an unusual and atypical presentation for hydronephrosis. This appearance suggests multifocal infundibular stenosis, and could represent infundibular pelvic dysgenesis (part of the spectrum of multicystic dysplastic kidney). 2. The presence of debris within these dilated calices raises suspicion of infection. 3. Increased left renal echogenicity consistent with medical renal disease, without hydronephrosis. 