Figure 1
Radiography
Supine abdominal radiographs detected a round calcification in the left upper abdomen.
Pyelocalyceal diverticula
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsVoudouri P, Deligiannidis T, Xenou A, Melidis D
Connected authors
59 years, female
Clinical History
Α 59-year-old woman presented with abdominal discomfort and unrelated symptoms without haematuria or lower urinary tract symptoms.
Imaging Findings
Abdominal ultrasonography revealed a left renal parenchymal cyst in the upper pole, 2x2 cm, with mobile hyperechogenic material and posterior acoustic shadow.
Supine abdominal radiograph detected a round calcification in the left upper abdomen.
Contrast enhanced spiral CT showed a well-defined 2 cm left renal cyst abutting the renal sinus with curvilinear calcification in the posterior wall. Prone CT scans taken 50 minutes after intravenous contrast injection demonstrated movement of the plaque like calcific density towards the anterior wall of the cyst and contrast opacification of the cyst, confirming cyst communication.
Supine abdominal radiograph detected a round calcification in the left upper abdomen.
Contrast enhanced spiral CT showed a well-defined 2 cm left renal cyst abutting the renal sinus with curvilinear calcification in the posterior wall. Prone CT scans taken 50 minutes after intravenous contrast injection demonstrated movement of the plaque like calcific density towards the anterior wall of the cyst and contrast opacification of the cyst, confirming cyst communication.
Discussion
Calyceal diverticula are smooth-walled, urine-filled cavities lined with transitional cell epithelium, communicating with the collecting system through a narrow channel. Although the lining is nonsecretory, the diverticulum contains urine due to passive filling from the adjacent collecting system. The aetiology is probably congenital, resulting from failure of regression of the third or fourth division of the ureteric buds of the Wolffian duct. Two main types of diverticula are recognised: Type 1 , the most common , which is related to a minor calyx and Type 2 , which communicates with the renal pelvis or a major calyx. This last type is larger, tends to be symptomatic and is located in the central portion of the kidney. Up to 39% contains calculi or milk of calcium.The incidence is 2.1 to 4.5 per 1000 IVUs and is bilateral in 3% of cases.
Although rare and usually asymptomatic, calyceal diverticulum can result in a variety of urological problems including renal colic, haematuria, stone formation, urinary tract infection and hypertension.
Mobile calculus is a typically found in calyceal diverticulum. The mobility of the calculi within the calyceal diverticulum, which can be demonstrated on ultrasound or computed tomography, differentiates the calculi from the mural calcification of renal cyst.
Communication with the pelvicalyceal system differentiates calyceal diverticulum from renal cyst and this may be seen on computed tomography and is confirmed by contrast filling of the calyceal diverticulum in the delayed phase of computed tomography or intravenous urography.
The presence of an unusually mobile calculus or of milk of calcium that changes position on upright or lateral decubitus radiographs is highly characteristic.
Although rare and usually asymptomatic, calyceal diverticulum can result in a variety of urological problems including renal colic, haematuria, stone formation, urinary tract infection and hypertension.
Mobile calculus is a typically found in calyceal diverticulum. The mobility of the calculi within the calyceal diverticulum, which can be demonstrated on ultrasound or computed tomography, differentiates the calculi from the mural calcification of renal cyst.
Communication with the pelvicalyceal system differentiates calyceal diverticulum from renal cyst and this may be seen on computed tomography and is confirmed by contrast filling of the calyceal diverticulum in the delayed phase of computed tomography or intravenous urography.
The presence of an unusually mobile calculus or of milk of calcium that changes position on upright or lateral decubitus radiographs is highly characteristic.
Differential Diagnosis List
Pyelocalyceal diverticulum
Complicated cyst
Obstructed calyx
Final Diagnosis
Pyelocalyceal diverticulum
References
[1] Rathaus V, Konen O, Werner M, Shapiro Feinberg M, Grunebaum M, Zissin R (2001) Pyelocalyceal diverticulum: the imaging spectrum with empashasis on the ultrasound features. The British Journal of Radiology 74:595-601 (PMID: 11509394)
[2] Karen E. Driscoll, Christine Kim (2007) A novel approach to the treatment of a calyceal diverticulum. J Robotic Surg 1:203-205
[3] Gayer G, Apter S, Heyman Z, Morag B (1988) Pyelocalyceal diverticula containing milk of calcium-CT diagnosis. Clin Radiol 53:369-71 (PMID: 9630277)
[4] Jacobs RP, Kane RA. (1984) Sonographic appearance of calculi in renal calyceal diverticula. J Clin Ultrasound 12:289?291 (PMID: 6429206)
Case information
| URL: | https://www.eurorad.org/case/9056 |
| DOI: | 10.1594/EURORAD/CASE.9056 |
| ISSN: | 1563-4086 |
Figure 2
US
Abdominal ultrasonography revealed a left renal parenchymal cyst in the upper pole, 2x2 cm, with mobile hyperechogenic material and posterior acoustic shadow.
Abdominal ultrasonography revealed a left renal parenchymal cyst in the upper pole, 2x2 cm, with mobile hyperechogenic material and posterior acoustic shadow.
Figure 3
CT
Contrast enhanced spiral CT showed a well-defined 2 cm left renal cyst abutting the renal sinus with curvilinear calcification in the posterior wall.
Prone CT scans taken 50 minutes after intravenous contrast injection, demonstrated movement of the plaque like calcific density towards the anterior wall of cyst and contrast opacification of the cyst, confirming cyst communication.
Prone CT scans taken 50 minutes after intravenous contrast injection, demonstrated movement of the plaque like calcific density towards the anterior wall of cyst and contrast opacification of the cyst, confirming cyst communication.
Radiography
Supine abdominal radiographs detected a round calcification in the left upper abdomen.
US
Abdominal ultrasonography revealed a left renal parenchymal cyst in the upper pole, 2x2 cm, with mobile hyperechogenic material and posterior acoustic shadow.
Abdominal ultrasonography revealed a left renal parenchymal cyst in the upper pole, 2x2 cm, with mobile hyperechogenic material and posterior acoustic shadow.
CT
Contrast enhanced spiral CT showed a well-defined 2 cm left renal cyst abutting the renal sinus with curvilinear calcification in the posterior wall.
Prone CT scans taken 50 minutes after intravenous contrast injection, demonstrated movement of the plaque like calcific density towards the anterior wall of cyst and contrast opacification of the cyst, confirming cyst communication.
Prone CT scans taken 50 minutes after intravenous contrast injection, demonstrated movement of the plaque like calcific density towards the anterior wall of cyst and contrast opacification of the cyst, confirming cyst communication.