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Fig. 48.73. (A) Burkitt's lymphoma in a 6-year-old boy. (B) Lymphoma deposits in a hydronephrotic kidney. RK right kidney.

Fig. 48.74. Polycystic kidney.


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Renal Abnormalities (continued)

Ultrasonography of Burkitt's and other lymphomas and of leukemia may show multiple, ill-defined but variable sized tumors in both kidneys (Fig.48.73). In Burkitt's lymphoma the masses do not directly invade renal parenchyma. They are solid, hypoechoic space-occupying tumors, usually with good edge definition; the kidney is often enlarged and in young children may be massive. The calyces are distorted and splayed (see chapter on Burkitt's Lymphoma). Both kidneys are usually involved, but not symmetrically. Burkitt's lymphoma must be distinguished from congenital polycystic disease, in which the kidneys are large and may be lobulated, but are seldom so unevenly distorted (Fig.48.74). Accurate differentiation may not be possible with ultrasonography, but Burkitt's lymphoma is seldom confined to the kidneys and tumors are likely to be found elsewhere: the rest of the abdomen, particularly the ovaries and testes, should be scanned and the patient examined clinically.

In sickle cell disease, ultrasonography will demonstrate the papillary necrosis and scarring which result from infarction, usually in association with pyelonephritis.

Malaria causes nephrosis (blackwater fever) but the ultrasound changes are nonspecific. An enlarged spleen may distort the upper lateral aspect of the left kidney (see chapter on Fevers).


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