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© 2003 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 22:951-956 • 0278-4297

Case Series

Sonographic Features of Necrosed Renal Papillae Causing Hydronephrosis

S. Boopathy Vijayaraghavan, MD, DMRD, Sangampalayam Vedhanayagam Kandasamy, MS, MCh, Mylsamy Arul, MS, DNB (Uro) and Muniappan Prabhakar, MS

Vedhanayagam Hospital Private Ltd, Coimbatore, India.

Address correspondence and reprint requests to S. Boopathy Vijayaraghavan, MD, DMRD, 16 B Venkatachalam Rd, R. S. Puram, Coimbatore 641 002, India. Email: sonoscan{at}vsnl.com and sboopathy{at}eth.net.

Objective. To describe the sonographic appearance of ureteric obstruction due to necrosed papillae. Methods. In this study, carried out over 3 years 6 months, patients with diabetes mellitus who had renal colic were studied by sonography. Results. In 15 patients with hydronephrosis, there was a soft tissue mass of necrosed papillae filling the ureteric lumen at the site of obstruction. Necrosed papillae were seen in medullary cavities of the ipsilateral kidney in 5 patients. Ureteroscopic removal of necrosed papillae was done in 13 patients. One patient was not fit for an invasive procedure. Conclusions. When patients predisposed to renal papillary necrosis have renal colic, and sonography fails to show a ureteric calculus, it is best to look for necrosed papillae in the ureter, which may be causing obstruction.

Key Words: diabetes mellitus • hydronephrosis • renal colic • renal papillary necrosis • sonography

Abbreviations: RPN, renal papillary necrosis




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