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The Scintigraphic Drooping Lily Sign

Karine Sahakyan, Melissa R Spevak, Harvey A Ziessman

    Clinical Nuclear Medicine
    |March 15, 2018
    PubMed

    Insights

    The "scintigraphic drooping lily" sign on renal scans can indicate a duplicated kidney system. This finding, seen in infants with hydronephrosis, helps differentiate obstructed upper pole moieties from normal kidney structures.

    Area of Science:

    • Pediatric Radiology
    • Nuclear Medicine
    • Urology

    Background:

    • The "drooping lily" sign is a recognized imaging finding in duplicated renal collecting systems.
    • It typically refers to the displacement of a functioning lower pole moiety by an obstructed upper pole system on contrast imaging.
    • Accurate identification is crucial for appropriate patient management.

    Observation:

    • A 2-month-old infant presented with prenatal hydronephrosis.
    • A "scintigraphic drooping lily" sign was observed on a Technetium-99m dimercaptosuccinic acid (Tc-DMSA) renal scan.
    • This indicated a duplicated renal collecting system with an obstructed upper pole moiety.

    Findings:

    • The scintigraphic findings were confirmed by ultrasound and voiding cystourethrography.
    • The case highlights the utility of nuclear medicine scans in diagnosing complex renal anomalies.
    • The "drooping lily" sign on Tc-DMSA scan accurately depicted the obstructed upper pole moiety.

    Implications:

    • Recognizing the "scintigraphic drooping lily" sign is vital for accurate diagnosis in infants with hydronephrosis.
    • This sign aids in differentiating duplicated collecting systems from other renal abnormalities.
    • Correlating scintigraphic findings with anatomical imaging prevents misinterpretation of the lower pole moiety.

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