Purpose or Case Report: Interrogation of the renal vasculature in the pediatric patient is challenging, requiring meticulous sonographic technique and attention to detail. Ultrasound, and Doppler sonography in particular, plays a key role in evaluation of suspected renal vascular abnormalities given its portability, availability, and lack of ionizing radiation. Attempts must be made to optimize the performance of this technically challenging examination. Additionally, the radiologist must be familiar with the frequently subtle findings in these examinations.

The purpose of this exhibit is the educate the audience on the proper performance and interpretation of renal Doppler ultrasound. We will first review the normal vascular anatomy of the kidney and normal arterial and venous waveforms. Sonographic technique will be reviewed, including tips and tricks for optimizing image acquisition and including a review of appropriate technique for color and spectral Doppler interrogation. A case-based pictorial review will then follow, including the following diagnoses:

1. Renal artery thrombosis
2. Renal vein thrombosis
3. Renal artery stenosis, including discussion of congenital vs. acquired causes and associated syndromes
4. Manifestations of systemic processes in the renal vasculature (including patent ductus arteriosis, aortic coarctation, and LVAD)
5. Spectrum of abnormal vascular findings in renal transplants
6. Pseudoaneurysm and AV fistula
7. Nutcracker syndrome
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