Perlman syndrome is a rare entity characterized by hypotonia, facial dysmorphism, gigantism, and visceromegaly including nephromegaly. The current case illustrates the ultrasonographic and computed tomographic appearances of renal abnormalities in this condition. Findings in Perlman syndrome can overlap with and need to be distinguished from two more common clinical entities: prune-belly and Beckwith-Wiedemann syndromes. Additional cranial findings previously unreported are also described.