Hydronephrosis

Patient with neurogenic bladder

Patient with neurogenic bladder

Calyceal dilatation of any cause. Synonomous with pelvicaliectasis and pelvicaliceal dilatation.

Ultrasound Appearance

• Communicating anechoic fluid-filled spaces within sinus complex
• Renal enlargement

Mild hydronephrosis: Small separation of calyceal pattern (splaying), normal bright sinus echoes, normal parenchymal thickness

Moderate hydronephrosis: Ballooning of major and minor calyces, diminished sinus echoes, normal or thinned parenchymal thickness

Severe hydronephrosis: Massive dilatation of renal pelvis and calyces, associated with cortical thinning and loss of normal renal sinus echogenicity

Ultrasound grading

• Grade 0: Homogeneous central renal sinus complex without separation
• Grade 1: Separation of central sinus echoes of ovoid configuration, continuity of echogenic sinus periphery
• Grade 2: Separation of central sinus echoes of rounded configuration, dilated calycesces connecting with renal pelvis; continuity of echogenic sinus periphery
• Grade 3: Replacement of major portions of renal sinus; discontinuity of echogenic sinus periphery