Sonography of macrocysts in infantile polycystic kidney disease

The typical sonographic appearance of autosomal recessive polycystic kidney disease (ARPKD) has been described as symmetrically enlarged, echogenic kidneys with occasional visualization of small cysts. Modern sonographic equipment, however, allows a greater ability to show parenchymal detail, and multiple tiny cysts and occasionally dilated tubular structures have become apparent. In this report, we describe sonographic findings of ARPKD that are quite similar to the macroscopic appearance. Sonographic images show unusual focal rosettes consisting of a cluster of the radially oriented, dilated collecting tubules that are apparent on pathologic evaluation. It is important to recognize the focal rosette as a manifestation of ARPKD.