A term neonate develops an abrupt left flank mass, gross hematuria, and a platelet count of 60,000/mm3 on day 3 of life. Blood pressure is elevated. Which single investigation will best establish the diagnosis?

• A Voiding cystourethrogram
• B DMSA renal scan
• C Ultrasonography with Doppler of the renal vessels ✓
• D Micturating cystourethrogram with IV urography

Explanation

The triad of flank mass, hematuria and thrombocytopenia in a neonate is classic for renal vein thrombosis, often triggered by dehydration or birth asphyxia. Doppler ultrasonography demonstrates the echogenic thrombus in the renal vein or IVC and loss of flow, and is the diagnostic modality of choice. A VCUG evaluates reflux and valves but cannot show vascular thrombus, and a DMSA scan assesses cortical function, not acute venous occlusion.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.