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This is Pediatrics week 3 case 2 and

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the diagnosis were considering is hydronephrosis and

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renal obstruction.

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And you should see an image of a renal

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and bladder ultrasound as usual. We're beginning with images of

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the bladder and I'm just going to slowly scroll through these images. We

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have a nice well distended bladder. No obvious abnormalities.

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We're going to move on from the bladder to

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the kidney.

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And you may not have even noticed the transition from bladder to

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kidney. Let me go back.

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There's bladder.

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There's kidney they should not be so difficult

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to distinguish. So something is very wrong with

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this. Kidney. And in fact the closer you look the more you realize there's

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a thin rim of Cortex out here at the periphery and

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a very large fluid filled space. Centrally. This

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is not the normal architecture of the kidney. But rather this is

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the appearance of an obstructed right collecting system.

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So let's look at a few more images here. We

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can show some blood flow and the tissue surrounding this large collecting

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system hydronephrotic for sure, but not

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only is it hydronephrotic. It's a featureless kidney.

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We don't see dilatation of the pelvis as you

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know, opposed to the calises or pelvo caliseal

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deal notation. We just see almost unilocular

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appearance to the kidney which suggests that

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it's a faced all of the architectural distinctions of

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the collecting system. This is severe obstruction severe

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hydronephrosis, and

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this is

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A very complete obstruction. So what are the

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things that can cause complete obstruction in a kidney? Well, you know

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possibly trauma or stones but more commonly A

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congenital obstruction like in atresia, like

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a upj obstruction a uretero pelvic Junction

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obstruction and if we scroll through the exam we

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can look for any signs of a dilated ureter if

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we see a tortuous and dilated ureter then

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we might suspect the obstruction is much further down

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in this case. All we saw was that pelvis and

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calluses here. We are on the left side a much

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more normal appearance to the kidney normal size. We've got

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cortex we've got intervening renal medullary pyramids.

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We're not worried about this left side.

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Normal blood flow here we go back to

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the right side. These are prone images which sometimes can give

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us a slightly different perspective and we see the same thing unilocular

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thin renal cortex, very severe obstruction

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severe hydronephrosis. And this

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is most likely a failure at the

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ureteropelvic junction of complete communication

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between the ureter and the kidney and remember

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the kidneys start out low, and then they have to ascend and

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there is a ureteric bud and then there is

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the renal

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The mesenchyme and there needs to be a complete

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connection and then opening between those

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structures.

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And if there isn't then you get some level of atresia and that's

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what we see here. This is a complete obstruction. There's going to be a

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piloplasty to repair this where the urologists

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go in and cut out the atretic segment

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anytime. We see a complete obstruction. We have

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to think about upj obstruction. It's one

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of the most common causes of this condition. If you see

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it on one side look carefully at the other side because one

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upj obstruction makes it more likely that

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there's a second

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that's the end of the case.