November Case #1: Discussion

The initial images illustrate a multicystic kidney which is grossly enlarged. There appears to be flow through the ureter as demonstrated by color flow in the transverse bladder view.

The differential for this patient should include:
1. hydronephrosis
2. renal cysts
3. polycystic kidney disease
4. tuberous sclerosis

To aid us in this differentiation, we took a quick scan through his liver and found the following:


The above pictures illustrate multiple cysts on the liver. This, along with the findings of bilateral multicystic kidneys and bilateral urine flow demonstrated by bladder jets, supports the diagnosis of Polycystic Kidney Disease.

Polycystic Kidney Disease

• Autosomal dominant form found in adults.
• Kidneys appear enlarged bilaterally due to multiple cysts of varying sizes.
• In advanced stages, cysts may destroy renal tissue and cause renal failure and hypertension.
  
• Cysts may be visualized as early as the 2nd decade of life
• Associated with cysts in the liver, pancreas and spleen and arterial aneurysms, especially berry aneurysms in 20% of cases