Clinical History
An 80 years old female with hidden history of urinary bladder cancer evaluated for acute abdomen. The patient underwent ultrasound examination and
computed tomography examination.
Imaging Findings
An 80 years old female with hidden history of urinary bladder cancer evaluated for acute abdomen. The patient underwent ultrasound examination and
computed tomography examination. The ultrasound examination wasn’t diagnostic due to increased amount of air. Computed tomography scans depicted an enlarged (20X13X7 cm), hypodence mass, with sharp margins occupying all the left
abdominal cavity The lesion presented with diaphragms and high attenuation collection of blood within it an its periphery as well. There was higher than water attenuation fluid at the corresponding
posterior retroperitoneal space. They weren’t any visible renal parenhymatic tissue at the right kidney. There wasn’t enhancement of the lesion after contrast medium administration, The
left ureter observed dilated at its route from ureteropelvic junction to the urinary bladder junction, with stone formation within it. The right kidney was atrophic as well with cystic lesions.
They weren’t any visible cystic lesion at the hepatic parenchyma, or pancreas. The patient underwent nephrectomy and the left kidney was removed with the corresponding ureter. The macroscopic
findings were that of total degeneration of the left kidney with absence of any viable renal parenchyma. The macroscopic specimen examined cytological and the diagnosis confirmed, cystic
degeneration of the left kidney and the corresponding ureter. The left ureter was obstructed due to preceding irradiation therapy for the bladder cancer.
Discussion
Obstructive nephropathy is responsible for end-stage renal failure in approximately 4% of persons. Obstruction of the
flow of the urine can occur anywhere in the urinary tract. Obstruction can be caused by luminal bodies, luminal defects, and extrinsic compression by vascular, neoplastic, inflammatory or other
processes, or dysfunction of the autonomic nervous system or smooth muscle of the urinal tract.
Specifically intramural causes can attributed to calculus, clot, renal papilla or fungus ball. The intrinsic
causes can be congenital (caliceal infudibular obstruction uteropelvical junction obstruction, ureteral stricture or valves, urethral valves, prune belly syndrome) and acquired such as polyps or
carcinoma of the renal pelvis, ureters or bladder.
Extrinsic causes of obstructive uropathy are congenital aberrant vessels, neoplastic, benign, retroperitoneal,
metastatic tumors or retroperitoneal extension of pelvic or abdominal tumors. Other causes are inflammatory processes such as retroperitoneal fibrosis, inflammatory bowel disease, diverticulitis
and infection or abscess. Gynecological causes can be pregnancy, uterine prolapse, surgical disruption or progression. At last functional causes leading to obstructive uropathy are neurogenic
bladder and drugs(anticholenegics, antidepressants, calcium channel blockers)
The functional and clinical consequences of the urinary tract obstruction depend on the developmental stage of
the kidney at the time of the obstruction occurs, severity of the obstruction and weather the obstruction affects one or both kidneys. Cystic replacement of kidney is the end result and presents
increased incidence (46-49%) in
patients with chronic renal dialysis particularly after 3 years.
Complications of this situation are the increased risk of hemorrhage (within the cyst subcapsular and
perinephric) and development of adenocarcinoma (increased incidence uo to seven times).
The imaging differential diagnosis includes polycystic renal disease (usually bilateral dilated kidneys with
associated hepatic, spleenic, pancreatic and lung cysts), polycystic kidney (young child), polycystic nephroma (contrast enhancement of the cystic wall and the diaphragms). In contrast cystic renal
replacement is usually unilateral, is not associated with cysts in another organ and does not present with enhancing wall.
The imaging and histopathological findings are compatible with destructive changes in renal and ureteral
architecture.
Differential Diagnosis List
Cystic left kidney degeneration (obstructive type).
Final Diagnosis
Cystic left kidney degeneration (obstructive type).
