What causes the Drooping Lily sign in the kidneys on imaging studies?
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Answer:
The Drooping Lily sign is associated with a duplex renal collecting system, particularly when there is obstruction of the upper moiety, often due to a ureterocele. This leads to distension of the upper moiety, which compresses and displaces the lower, non-obstructed moiety, resulting in its characteristic “drooping” appearance.
Why is it called so?
The sign is named for its resemblance to a wilting or drooping lily, due to the lateral and inferior displacement of the functioning lower pole moiety, which has fewer calyces and appears compressed.
Pathophysiology
The pathophysiology involves the obstruction of the upper renal moiety’s ureter, typically by a ureterocele, which causes the upper moiety to become dilated and hydronephrotic. This dilation compresses the lower moiety, displacing it downward and laterally, creating the “drooping” appearance seen on imaging studies like excretory urography. The lower moiety remains functional but is distorted, contributing to the sign’s characteristic appearance.
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