A 10 year old with fever and not passing urine


During scanning practice the candidates asked if we could go and scan this 10 year old child who was admitted with fever, generally unwell and passing less urine.

Not u/e’s were available , a raised wcc was noted.

Had had an in/out catheter for urinary retention. No catheter was in place currently

His right kidney looked like this


and his left kidney looked similar



I spent a long term confirmed these were indeed the kidneys as looked so grossly abnormal.

They didn’t look like the typical appearance of polycystic kidneys and I had no idea what I was looking at. I am less experienced with paediatric ultrasound but found out that they should have a relatively similar appearance to adults after one year of age, before this they have more prominent pyramids.

Happily the boy’s family could afford a formal ultrasound which suggestion

“massive dilation of both calcyes and thinning of the cortex, inside the fluid filled kidneys are low level internal echoes which display and fluid-fluid interface. Suggestive of pyelonephritis.

He was already on iv antibiotics.


Learning points.

1/ In low resource settings we often have quiet extreme or late presentations of infective processes.

2/If uncertain of diagnosis, broad spectrum antibiotics are often a good idea.

3/ We will not always get the diagnosis first time with POCUS.