Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

6-week-old infant girl with prenatal diagnosis of hydronephrosis. Postnatally, she had minimal dilatation of the right renal pelvis (Figure 1) and very mild dilatation of the left renal pelvis (Figure 2). VCUG showed bilateral reflux, right grade 3 and left grade 4 (Figure 3). There was prompt drainage of the refluxed material (Figure 4), accounting for the unremarkable ultrasound exam. Ultrasonography can suggest reflux, but it routinely underestimates the presence and degree of reflux.

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