A 13-year-old NM DSH was presented for evaluation of weight loss, anorexia for 2-3 days, and a few episodes of vomiting. Abnormalities on physical examination were pale mucus membranes and right nephromegaly. Abnormalities on CBC and serum biochemistry were anemia, neutrophilia, azotemia, and hyperphosphatemia.
Obstructive uropathy (lith, neoplasia), pyelonephritis, hydronephrosis, renal abscess, renolith
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Bilateral parenchymal renomegaly. Pyelonephritis pattern. There is a strong potential for emerging renal lymphoma. Bladder calculi. Mesenteric lymphadenopathy. Reactive lymph node versus potential lymphoma.
The left kidney was enlarged and measured 5.4 cm with pyelectasia and ill defined fat. Decreased corticomedullary definition was noted with focal capsular expansion at the caudal pole. The right kidney was also moderately to severely enlarged with corticomedullary and pelvic calculi. Loss of corticomedullary detail was noted. Minor subcapsular halo formation was noted with periserosal inflammation. The urinary bladder presented multiple small calculi measuring 0.1-0.3 cm. Mesenteric lymph nodes were enlarged and measured 1.5 cm and 1.8 cm. These lymph nodes were significantly hypoechoic, yet architecture was not distorted at this point. Hyperechoic reactive fat was noted.
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