Case 1

The images above and highlighted below show echogenic appearance of the renal pyramids which is consistent with Medullary nephrocalcinosis. It results from calcification in the medullary portions of the kidney in the distribution of the renal pyramids. This condition varies from a subtle distribution of the calcifications to a florid deposition of calcium throughout the pyramids. With minimal calcifications, there is no shadowing. US is more sensitive than CT and plain films for earlier diagnosis of this condition.

Ultrasound features of medullary nephrocalcinosis:
1. Early- hyperechogenicity in the periphery of the pyramids
2. Mid- diffusely hyperechoic pyramids, fine to coarse echotexture
3. Late: clumps of calcium, shadowing