Presentation
Antenatal detection of an abnormality of the right collecting system.
Patient Data
Tc-99m MAG3 dynamic renal study with furosemide
Furosemide (Lasix) was administered to the patient as per an F+0 protocol (at the same time as the radiotracer).
There is reduced perfusion to the right kidney when compared to the left. On the initial two minute image, there is prompt extraction of tracer by the left kidney, with comparative reduction in uptake by the right. There is cortical retention of tracer is abnormally prolonged in the right kidney.
There is pooling of excreted radiourine in the right ureter, which persists on delayed imaging. The point of hold up is at the vesicourteric juntion (VUJ). The Lasix half washout time of the right kidney is prolonged (22 minutes). The Lasix half washout time in the left kidney is normal.
Differential renal function is asymmetrical, the right kidney contributing 33% to overall function and the left kidney contributing 67%.
Case Discussion
This case demonstrates the features of VUJ obstruction on dynamic renal scintigraphy, augmented with furosemide. In this case, the obstruction is severe enough to cause reduction in renal function and reduced perfusion to the affected kidney. Furosemide is administered if there is a question of renal tract obstruction to improve the accuracy of the dynamic renal study.
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