Abdominal Imaging
ª Springer Science+Business Media New York 2015 Published online: 17 June 2015
Abdom Imaging (2015) 40:2916–2917 DOI: 10.1007/s00261-015-0484-y
The ‘‘bunch of grapes’’ sign Pavani Thotakura, Raymond B. Dyer Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem 27157, NC, USA
A ‘‘bunch of grapes’’ (Fig. 1) metaphorically describes the classic imaging appearance of the pyeloinfundibular type of multicystic dysplastic kidney (MCDK). MCDK is the most common form of infantile renal cystic disease and the second most common cause of an abdominal mass in an infant [1]. Abdominal ultrasound is the examination of choice for evaluation of the infant with an abdominal mass. Sonograms of MCDK typically show multiple noncommunicating cysts, the appearance of which has been likened to a bunch of grapes (Fig. 2). Of note, MCDK with a larger central cyst can mimic severe hydronephrosis. Currently, many MCDK cases are diagnosed on prenatal ultrasonography (sensitivity of 80–100 %) with follow-up sonograms during the first few days of life and one month later to confirm the diagnosis [2]. Over time, the affected kidney often involutes, and can even appear agenetic [3].
Correspondence to: Pavani Thotakura; email: pthotaku@wakehealth. edu
Fig. 1. Bunch of grapes. Adopted from http://www.thecab bagebox.com/red-grapes retrieved 3/20/2015.
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P. Thotakura and R. B. Dyer: The ‘‘bunch of grapes’’ sign
Fig. 2. Transverse (a) and longitudinal (b) sonographic images of a dysplastic left kidney in an infant demonstrating the ‘‘bunch of grapes sign’’ of MCDK with little to no normal intervening renal parenchyma.
Fig. 3. Axial contrast-enhanced CT image through the upper abdomen in an adult demonstrating a calcified ‘‘bunch of grapes’’ in the MCDK on the left.
Fig. 4. Axial T2-weighted MR sequence through the upper abdomen in an adult demonstrating a ‘‘bunch of grapes’’ appearance of the MCDK on the right.
References Theories of pathogenesis of MCDK include both primary failure of ureteric bud activity, and disruption of renal development because of fetal urinary outflow obstruction [4]. Although typically considered an infantile disease, undiscovered MCDK can be encountered in adults, where the bunch of grapes appearance is recapitulated on other imaging modalities such as CT (Fig. 3) or MR (Fig. 4).
1. Sarhan OM, Alghanbar M, Alsulaihim A, et al. (2014) Multicystic dysplastic kidney: impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol 10:645–649 2. Eckoldt F, Woderich R, Wolke S, et al. (2003) Follow-up of unilateral multicystic kidney dysplasia after prenatal diagnosis. J Matern Fetal Neonatal Med 14:177–186 3. Strife JL, Souza AS, Kirks DR, et al. (1993) Multicystic dysplastic kidney in children: US follow-up. Radiology 186:785–788 4. Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 24:233–241
ª Springer Science+Business Media New York 2015 Published online: 17 June 2015
Abdom Imaging (2015) 40:2916–2917 DOI: 10.1007/s00261-015-0484-y
The ‘‘bunch of grapes’’ sign Pavani Thotakura, Raymond B. Dyer Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem 27157, NC, USA
A ‘‘bunch of grapes’’ (Fig. 1) metaphorically describes the classic imaging appearance of the pyeloinfundibular type of multicystic dysplastic kidney (MCDK). MCDK is the most common form of infantile renal cystic disease and the second most common cause of an abdominal mass in an infant [1]. Abdominal ultrasound is the examination of choice for evaluation of the infant with an abdominal mass. Sonograms of MCDK typically show multiple noncommunicating cysts, the appearance of which has been likened to a bunch of grapes (Fig. 2). Of note, MCDK with a larger central cyst can mimic severe hydronephrosis. Currently, many MCDK cases are diagnosed on prenatal ultrasonography (sensitivity of 80–100 %) with follow-up sonograms during the first few days of life and one month later to confirm the diagnosis [2]. Over time, the affected kidney often involutes, and can even appear agenetic [3].
Correspondence to: Pavani Thotakura; email: pthotaku@wakehealth. edu
Fig. 1. Bunch of grapes. Adopted from http://www.thecab bagebox.com/red-grapes retrieved 3/20/2015.
2917
P. Thotakura and R. B. Dyer: The ‘‘bunch of grapes’’ sign
Fig. 2. Transverse (a) and longitudinal (b) sonographic images of a dysplastic left kidney in an infant demonstrating the ‘‘bunch of grapes sign’’ of MCDK with little to no normal intervening renal parenchyma.
Fig. 3. Axial contrast-enhanced CT image through the upper abdomen in an adult demonstrating a calcified ‘‘bunch of grapes’’ in the MCDK on the left.
Fig. 4. Axial T2-weighted MR sequence through the upper abdomen in an adult demonstrating a ‘‘bunch of grapes’’ appearance of the MCDK on the right.
References Theories of pathogenesis of MCDK include both primary failure of ureteric bud activity, and disruption of renal development because of fetal urinary outflow obstruction [4]. Although typically considered an infantile disease, undiscovered MCDK can be encountered in adults, where the bunch of grapes appearance is recapitulated on other imaging modalities such as CT (Fig. 3) or MR (Fig. 4).
1. Sarhan OM, Alghanbar M, Alsulaihim A, et al. (2014) Multicystic dysplastic kidney: impact of imaging modality selection on the initial management and prognosis. J Pediatr Urol 10:645–649 2. Eckoldt F, Woderich R, Wolke S, et al. (2003) Follow-up of unilateral multicystic kidney dysplasia after prenatal diagnosis. J Matern Fetal Neonatal Med 14:177–186 3. Strife JL, Souza AS, Kirks DR, et al. (1993) Multicystic dysplastic kidney in children: US follow-up. Radiology 186:785–788 4. Hains DS, Bates CM, Ingraham S, Schwaderer AL (2009) Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 24:233–241
