Fig. 19

The same 13-year-old girl as in Fig. 18, with subsequent internal haemorrhoage within a left-sided Wilms’ tumour. a, b At diagnosis, the initial longitudinal (LS) and transverse (TS) ultrasound images of the left kidney (LK) reveal a large echogenic mass (red arrows) in the upper pole of the kidney, with some preserved renal tissue in the lower pole (white arrows). Some scant internal colour Doppler flow is noted within the mass. c, d A month later, after a sudden drop in the haemoglobin levels accompanied with intense abdominal pain, the ultrasound images of the left kidney reveal a larger, more heterogenous mass (red arrows) with some internal necrosis (white asterisk) and no internal colour Doppler flow in keeping with a large haematoma. It was not possible to clearly delineate the left renal vein at either the initial or subsequent ultrasound studies