Urinary bumps

bilateral tumor of the kidneys and posisible tumor of the urinary bladder.
next step: punction of the kidneys.
thanks for sharing. very interesting

renal pseudocyst with heterogeneous content (I assume pus)

Cistitis, ovary

Cool case! Thanks for sharing,
Thoughts: bilateral changes to renal parenchyma with poorly defined, heterogeneous lesions causing distortion of the normal renal architecture and renal capsule. Possibly small amount of enechoic free fluid around the right kidney capsule. Generalised, irregular thickening of the bladder wall with loss of distinct wall layering. Bladder is minimally filled with anechoic urine.
Ddx: metastatic neoplasia most likely with spread to kidneys and bladder (transitional cell carcinoma vs lymphoma vs other) vs chronic cystitis with granulomatous inflammation of the kidneys vs cystitis with bilateral neoplastic or benign change to kidneys.
Next steps: traumatic catheterisation of the bladder for cell collection and urinalysis, consider FNA of kidneys for cytology

Left kidney- Loss of CM distinction, multiple heterogeneous nodules, peri-renal steatitis, subcapsular edema (or possibly subcapsular hypoechoic tissue).
Right kidney- similar loss of CM distinction, peri-renal steatitis, subcapsular fluid with a hypoechoic, heterogeneous mass. Hydronephrosis with possibly dilated proximal ureter as well (likely as a result of the renal mass).
Urinary bladder diffusely irregular and thickened.
ddx: abscess, neoplasia, possibly FIP. Would FNA the renal nodules for cytology and culture and c/s of urine.

lymphoma at the kidney
renal wall imflammation

urinary bladder neoplasia, left kidney neoplasia, right kidney pyeloectasia maybe because of ureteral occlusion or bacterial cystitis and left kidney abscesses and right kidney pyeloectasia (pyelonephritis).
Urinoanalysis and antibiogram, FNA left kidney

Left Kidney
3 Nodular lesions, primarily involving the cortex. The nodules are heterogenous with a portion of the nodule having a hyperechoic, nearly striated appearance
There is questionable if any blood flow on Color Flow
Scant volume perinephric fluid
Hyperechoic adipose tissue surrounding kidney

Right kidney
There is a mass lesion affecting ~ 80 % of the cranial portion of the kidney. The mass is heterogeneous and does not appear to have any blood flow on color flow
There is a large anechoic region in the center of the kidney. Briefly a linear anechoic tubular structure is seen extending caudally. This is suggestive of a dilated ureter with hydronephrosis.

Urinary bladder
The urinary bladder wall is thickened especially the caudal ventral wall, measuring ~ 1.5 cm in thickness. It is hypoechoic.

Ddx:
1) Granulomatous lesions (secondary to bacterial, fungal or parasitic infection)
2) Neoplasia, the lack of blood flow makes this a little less likely

Next Step Diagnostics:
- If not done already - Min Data Base of CBC/Chem/Lytes, thoracic/abdo rads, FELV/FIV complete U/A with sediment and culture
- Check travel history with owner.
- FNA of renal lesions. If FNA is non-diagnostic consider Tru-Cut Biopsy of lesions.

Thank you for this great case, I looove them !
So here are my thoughts : Kidney : nodular lesions of mixed echogenicity that are disturbing profoundly the architecture of both kidney, and deforming the capsule of the organ, doppler : periphery of the lesion is vascularized but the center receives little if any vascularisation. Bladder : loss of the wall architecture, marked thickening of the cranio ventral aspect of the wall, suspect mineralization of this portion too. Sediment in the dependent area of the bladder. Ccl : Kidney : serious infectious process (ie bacteria , crypto...PIF less likely) or neo, bladder : cystitis, neo less likely. To do next : FNA kidney, urinanalysis, CBC...

very interesting. Frank

thank you for sharing

Thank you !!! Always full of surprises !

The images after chemotherapy are amazingly different. Quite a response especially for high grade lymphoma!