EURORAD ESR

Case 15112

Anasarca with normal glomerular filtration and renal imaging appearance: think nephrotic syndrome !

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 29 year(s)
 
 
  • Figure 1
    Plain chest radiograph

    Postero-anterior chest radiograph showed bilateral pleural effusions (+), more on the right side.

     
    Area of Interest: Lung; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;
     
     
  • Figure 2
    Ultrasound
     

    Ultrasound confirmed anechoic right (a) and left-sided (not shown) pleural effusions (+), without abnormalities of liver, portal venous system and spleen.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The poorly distended gallbladder showed mild, stratified oedematous mural thickening (thin arrows in c&d), without lithiasis and pericholecystic fluid.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The poorly distended gallbladder showed mild, stratified oedematous mural thickening (thin arrows in c&d), without lithiasis and pericholecystic fluid.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The kidneys (d,e) showed normal size, morphology, parenchymal thickness and echogenicity. On the left side minimal perinephric fluid (arrowhead in e) was noted. Absent hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The kidneys (d,e) showed normal size, morphology, parenchymal thickness and echogenicity. On the left side minimal perinephric fluid (arrowhead in e) was noted. Absent hydronephrosis.

     
    Area of Interest: Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;
     
     
  • Figure 3
    Precontrast and contrast-enhanced body CT
     

    Unenhanced scans at lung bases showed bilateral water-attenuation pleural effusions (+) consistent with transudates, without pleural thickening, active lung consolidation and mediastinal adenopathies.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The kidneys showed normal size, parenchymal thickness and nephrogram. Peritoneal (o), perinephric and fascial fluid (arrowheads) was present. Note bilateral pleural effusions (+).

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The kidneys showed normal size, parenchymal thickness and nephrogram. Peritoneal (o) fluid was present. Note oedematous gallbladder mural thickening (thin arrow).

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The kidneys showed normal size, parenchymal thickness and nephrogram. Minimal peritoneal (o) fluid was present. Note oedematous gallbladder mural thickening (thin arrow), pleural effusion (+).

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    The retroperitoneal perinephric and fascial fluid (arrowheads) was bilateral and most prominent below the kidneys. Additionally, abundant subcutaneous and fascial fluid (*) was noted in the dependent dorsum.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;

    Additionally, abundant subcutaneous and fascial fluid (*) was noted in the dependent dorsum.

     
    Area of Interest: Kidney; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Metabolic disorders;
     
     
Postero-anterior chest radiograph showed bilateral pleural effusions (+), more on the right side.
 
Ultrasound confirmed anechoic right (a) and left-sided (not shown) pleural effusions (+), without abnormalities of liver, portal venous system and spleen.
 
The poorly distended gallbladder showed mild, stratified oedematous mural thickening (thin arrows in c&d), without lithiasis and pericholecystic fluid.
 
The poorly distended gallbladder showed mild, stratified oedematous mural thickening (thin arrows in c&d), without lithiasis and pericholecystic fluid.
 
The kidneys (d,e) showed normal size, morphology, parenchymal thickness and echogenicity. On the left side minimal perinephric fluid (arrowhead in e) was noted. Absent hydronephrosis.
 
The kidneys (d,e) showed normal size, morphology, parenchymal thickness and echogenicity. On the left side minimal perinephric fluid (arrowhead in e) was noted. Absent hydronephrosis.
 
Unenhanced scans at lung bases showed bilateral water-attenuation pleural effusions (+) consistent with transudates, without pleural thickening, active lung consolidation and mediastinal adenopathies.
 
The kidneys showed normal size, parenchymal thickness and nephrogram. Peritoneal (o), perinephric and fascial fluid (arrowheads) was present. Note bilateral pleural effusions (+).
 
The kidneys showed normal size, parenchymal thickness and nephrogram. Peritoneal (o) fluid was present. Note oedematous gallbladder mural thickening (thin arrow).
 
The kidneys showed normal size, parenchymal thickness and nephrogram. Minimal peritoneal (o) fluid was present. Note oedematous gallbladder mural thickening (thin arrow), pleural effusion (+).
 
The retroperitoneal perinephric and fascial fluid (arrowheads) was bilateral and most prominent below the kidneys. Additionally, abundant subcutaneous and fascial fluid (*) was noted in the dependent dorsum.
 
Additionally, abundant subcutaneous and fascial fluid (*) was noted in the dependent dorsum.
 
 
 
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