The mystery of the periprostatic vessels:

Whilst doing a TRUS (Transrectal Ultrasound scan) for the prostate, seminal vesicles, etc., I have often come across these large, anechoic, tubular structures (V) on either side of the lateral lobes of the prostate. After reading extensively on the topic, I have found few answers. In this transverse section, the tubes (V) are seen well.
Note the inhomogenous echotexture of the prostate, with some hyperechoic area in the left side of the inner gland s/o chronic prostatitis. The patient was a young man with history of chronic dysuria and lower abdominal pain.























On sagittal section, the structures can be traced anteriorly and inferiorly.. definitely not the ureters.









Oblique transverse sections show the vessels communicating with their counterpart from the other side. Obviously these are vessels, most likely to be the periprostatic venous plexus.

The periprostatic veins communicating freely anterior to the prostate.

Diagnosis: prostatitis with dilatated periprostatic veins.

Sonography of bilateral renal agenesis in a fetus:

This is yet another case of bilateral renal agenesis.
This case is presented by Dr. Ajit Athale, MD, from Baroda, India. He describes the findings nicely. These images are of a fetus of 28 weeks.
Here we can see the "LYING DOWN" ADRENAL SIGN, the diagnostic finding ofof renal agenesis. In renal agenesis, the adrenals are free to occupy the space left in the renal fossa. So instead of being horizontal & being contoured frombelow by the upper pole of kidneys, they become vertical and flat, literally, plate like. This flattening of the adrenals is an indirect sign that the kidneys did not develop in the flanks. In fact, even on postmortem, I (Dr. Ajit) have seen pathologists mistaking gross specimen of discoid shaped adrenals as kidneys in case of bilateral renalagenesis, only to be corrected later on- by microscopy.This sign is of particular importance when one is notsure as to presence or absence of kidneys.Sometimes domes of diaphragm can masquerade as upperpoles of kidneys, especially when fetus is breathing (as shown in one of my pictures).This fetus also had club foot.

For more on this topic and view some more ultrasound images of renal agenesis, please visit my gallery of ultrasound images at:
http://drjoea.googlepages.com/obstetric-2

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