Figure 1
CT with contrast medium
Contrast enhanced CT scan shows a large cyst within the left renal pelvis, dislocating the renal parenchyma.The cyst appears with a disomogeneus filling due to the hemorragic infarction.
Imaging Findings
A 51 years old woman presented to our Hospital coplaining of left loin pain and presence of dark urine , with no history of urinary tract infection and similar condition .
On examination a palpable mass was suspected on the left flank .
Urine test revealed macroscopic haematuria , and the presense of uncoutable pus cells and RBCs .
Haematochemical test shows low Hb and increased creatinin level.
Ultrasonography demonstrate caliceal dilatation and increased renal volume asssociated with renal sinus cyst which has been confiremed by CT scan with and without contrast medium enhancement which appears as rounded dishomogenious mass with central hyperdense area referable to bleeding inside the cyst.
Discussion
The pelvic renal cyst is an uncommon lesion , in certain casistics it is about 5% approximatly, mainly in adults.
Many theories has been proposed to explain the pathogenisis of parapelvic cysts,one suggested that the cyst is arises from an embriological remnant such as Wolfian body in an other series it was found that most kidneys with parapelvic cyst had scars as an inflammatory basis for the parapelvic cysts was a possibility. It was suggested that the cyst represents lymphatic ectasia associated with thrombosis of lymphatic trunks of the kidney following inflammation.
In certain case the parapelvic cyst goes under complication such as infection, urinary tract obstruction with consequent hydronephrosis or bleeding.
Differential Diagnosis List
Bleeding parapelvic Cyst
Final Diagnosis
Bleeding parapelvic Cyst
References
[1]
Barloon TJ,Vince SW
Caliceal obstruction owing to a large parapelvic cyst: excretory urography, ultrasound and computerized tomography findings.
J Urol 1987 Feb ;137(2):270-1. (PMID: 3543407)
[2]
Androulakakis PA, Kirayiannis B, deliveliotis A
The parapelvic renal cyst. A report of 8 cases with particular emphasis on diagnosis and managenent.
Br J Urol 1980 oct; 52(5) :342-4. (PMID: 7427007)
[3]
Patel K, Caro PA, Chatten J
Parapelvic renal cyst causing UPJ obstrution. Investigation by IVP, ultrasound and CT.
Pediatr Radiol 1988; 19(1) : 2-5. (PMID: 3065710)
Case information
| URL: | https://www.eurorad.org/case/435 |
| DOI: | 10.1594/EURORAD/CASE.435 |
| ISSN: | 1563-4086 |
Figure 2
CT with contrast medium
Prone CT scan in the delayed fase shows the compression of the renal pelvis due to the hemorragic cyst.
Figure 3
CT with contrast medium
Contrast enhanced CT scan in the arterial fase shows the upper portion of the cyst without evidence of bleeding.
CT with contrast medium
Contrast enhanced CT scan shows a large cyst within the left renal pelvis, dislocating the renal parenchyma.The cyst appears with a disomogeneus filling due to the hemorragic infarction.
CT with contrast medium
Prone CT scan in the delayed fase shows the compression of the renal pelvis due to the hemorragic cyst.
CT with contrast medium
Contrast enhanced CT scan in the arterial fase shows the upper portion of the cyst without evidence of bleeding.