Ultrasound images Papillary necrosis

The renal papillae, which are situated in the medulla adjacent to the calyces, are susceptible to ischaemia due to relatively low oxygenation in the region of the medullary junction. This is particularly associated with diabetic patients and those on long-term anti-inflammatory or analgesic medication.
The papillae tend to necrose and slough off, causing blunting of calyces on IVU. Sloughed-off papillae may lodge in the entrance to the calyces, causing obstruction.
Papillary necrosis is difficult to detect on ultrasound unless advanced. It appears as prominent calyces with increased corticomedullary differentiation. IVU is the imaging method of choice (Fig.below).
Ultrasound images of Papillary necrosis. The calyces are mildly dilated with blunted, irregular margins and contain low-level echoes from sloughed papillae.
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