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.
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.