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So this was a renal ultrasound

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that was requested in a late preterm infant who presented

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with, um, congenital hydro nephrosis on antenatal imaging.

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So, uh, our sonographer is starting off showing us the

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urinary bladder, which has a little bit of an abnormal wall.

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This is a well descended urinary bladder,

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but the wall is a little bit ECD in appearance.

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Um, and a little bit thick walled on on these images.

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We'll go look at that on the cine later.

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Um, very abnormal kidney on this right side.

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So we have marked ectasis and not only central ectasis,

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but marked peripheral ectasis as well.

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And our renal parenchyma is very abnormal.

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We have marked thinning of the renal parenchyma, um,

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and like no cortico medullary differentiation

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of the renal parenchyma we have here,

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we can see a little bit of normal right adrenal gland at the

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superior aspect of this image.

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I'm gonna go to the cinematic image, so you can tell

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that these are, um, this is collecting system

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not varying size cysts, right?

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These con these, these, uh, these connects.

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So we're not dealing with a multilocular,

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multicystic dysplastic kidney.

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This is marked hydro nephrosis on this right side.

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Let's keep going. Um, with our still images,

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we have an abnormally dilated proximal ureter here, um,

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as we go transverse plane of the same thing.

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Okay, so now we're going to the left side

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and we have marked abnormalities of this left kidney.

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So we have this s squeezed looking sad renal parenchyma here

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with some ectasis and ectasis.

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And we have this very large multi septated complex fluid

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collection, um, in the perren space.

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So, um, it looks like this is, uh,

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a perinephric fluid collection

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that is compressing the renal parenchyma itself.

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So in the setting of an infant

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with a thick wall urinary bladder,

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severe right-sided hydro necrosis.

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And then we have this multi septated, um, um, collecting

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or uh, uh, multi septated complex collection in the

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perinephric space on the left.

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This is concerning for a oma

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after four nasal rupture on this left side.

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Um, so the most important thing that we're gonna need

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to do in this male infant with bilateral hydronephrosis

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and thick wall urinary bladder is rule out

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posterior urethra valves.

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So this is UTDP three on both sides.

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Um, let's go find the VCG to um, uh,

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make sure this patient does not have posterior urethral

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valves as the etiology

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of this congenital hydronephrosis bilaterally

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and thick wall urinary bladder.

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So this infant, uh, a few days later, uh, came

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to our fluoroscopy suite to undergo void cyst urethrogram.

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Um, he was an inpatient

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because he has this enteric tube which is extending into

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the, uh, gastric body.

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And then he came down to our fluoroscopy suite

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with this urinary bladder catheter already in place on

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This scout radiograph of the VCUG.

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So we start to instill contrast through

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that urinary bladder catheter.

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We see filling of this, uh, of the urinary bladder.

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Um, as we continue to fill the urinary bladder looks

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irregularly thick walled, we have wall irregularity

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and we are already starting

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to see this dilated abnormal posterior urethra with

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that catheter still in place.

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The anterior urethra is more normal in caliber

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and we have a pretty clear transition between the anterior

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and posterior urethra here as we continue

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to fill the urinary bladder.

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Um, we are looking up at the level

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of the kidneys on this VCG to see if we see any reflux, um,

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uh, contrast extending from the urinary bladder to the level

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of the kidneys, which, um, have a hard time seeing much

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of anything at that level on this fluoroscopic spot image.

3:53

Um, more images showing you number one,

3:56

this markedly abnormal trabecula, um,

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diminutive sized urinary bladder.

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Number two, we have removed our bladder catheter

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and we see this dilated posterior urethra.

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So the next thing we need to do is make sure we watch this

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patient void to see if we can see an actual valve.

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So here, this patient is voiding.

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This is just a last image hold.

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It is not an exposure,

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but we're highly concerned for valves.

4:22

Um, more of the same.

4:23

We're super concerned that there's a valve of tissue

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between this transition

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between the dilated posterior urethra

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and the anterior urethra.

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And here is our exposure, um,

4:33

with the catheter still in place actually.

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But, um, there is a transition

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between the dilated posterior urethra and anterior urethra.

4:41

Um, so this is here, so here is where the, the,

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um, catheter has been removed.

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We have, uh,

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a markedly td thick wall urinary bladder dilated posterior

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urethra, and it's hard to see the valve itself,

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but there is a clear transition.

4:57

Um, it's like this, uh, uh, like oblique look of, um,

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uh, at the post at the inferior aspect

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of the dilated posterior urethra.

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So this is posterior urethral valves in this infant.

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Um, we have multiple images trying to show you that,

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that transition point, um, here.

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So this was a case of congenital hydro necrosis,

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bilateral high grade congenital hydro necrosis

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that was confirmed on postnatal imaging.

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There was left sided for nasal rupture with Oma in

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that left perinephric space surrounding that left kidney,

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um, related to posterior urethral valves.

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So this patient will undergo a valve ablation

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and hopefully relieve that, uh, that outflow obstruction,

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uh, on that urinary bladder.