Contributed by
Mayo Clinic Rochester
Minsoo Kim, and Kelly Horst.
History
3-year-old male with epilepsy and recent inpatient admission for breakthrough seizures in the setting of RSV infection, now presenting to the ED with lethargy.
Images (Click any image to enlarge)
CT of the abdomen and pelvis shows a diffusely enlarged left kidney with striated nephrogram, wedge-shaped areas of cortical hypoenhancement, and multiple hypoattenuating renal parenchymal lesions.
Renal ultrasound shows multiple small complex cystic structures within the left kidney without internal color Doppler flow.
MRI of the abdomen shows multiple renal parenchymal lesions corresponding to the findings on CT and ultrasound which demonstrate T1 hypointensity, mild T2 hyperintensity, diffusion restriction, and peripheral enhancement. T2-weighted image with fat saturation shown.
DWI.
ADC map.
Post-gadolinium MRI.
Question
What is the next best step in management?
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