Kidney morphology in pregnancy using T2-weighted MRI.

AIM: To report the morphology of maternal kidneys captured on fetal magnetic resonance imaging (MRI) including kidney length, volume, renal pelvis diameter, and corticomedullary differentiation in pregnancy. MATERIALS AND METHODS: A retrospective study of maternal kidney morphology captured incidentally on fetal MRI. Women without chronic kidney disease, with a complete view of both kidneys and a singleton pregnancy were included. Kidney length, maximal renal pelvis diameter, kidney volume, and corticomedullary differentiation ratio were measured independently in duplicate. Associations with maternal and pregnancy variables were explored using linear regression. RESULTS: MRI images from 42 women were performed at 22-32 weeks' gestation. Serum creatinine concentrations are not checked routinely during pregnancy and were available for 15 (36%) women, with a median creatinine of 57 µmol/l (IQR: 50-63 µmol/l). Mean interpolar lengths were 10.9 and 10.4 cm for the left and right kidneys and varied with height. Mean maximal renal pelvis diameters were 9 mm and 12 mm, with upper reference intervals of 17 and 25 mm for the left and right kidneys, respectively. Renal volume in pregnancy was within the non-pregnant reference interval and varied with height and gestation. CONCLUSIONS: Maternal kidney length and volume in pregnancy are within the normal reference intervals for non-pregnant women. Renal pelvis diameter in pregnancy measured using MRI is substantially higher than described previously by ultrasound, with implications for routine reporting.

Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass.

A 65-year-old man presented with a right supraclavicular neck mass and right arm pain. Magnetic resonance imaging revealed a 96mm lesion in the upper thoracic paraspinal region extending into the deep supraclavicular fossa. The presentation was consistent with a sarcoma or lymphoma but fine needle aspiration was inconclusive. During open biopsy of the lesion, the patient had a rapid intraoperative haemorrhage of 1l from the tumour. Haemostasis could only be achieved by transarterial embolisation of the feeding vessel and the biopsy result confirmed Ewing's sarcoma. Open biopsy is considered the gold standard in the diagnosis of certain tumour types; however, the morbidity from haemorrhage must be considered. This case highlights the key role that transarterial embolisation can play in achieving haemostasis in the neck.