Renal calyceal diverticulum mimicking a large renal cyst-A case report

Ravirajendran Samson,Ramasamy Neelakandan,Kumaresan Natarajan,Thirunavukkarasu Chandru

doi:10.51248/.v40i3.44

Abstract

Renal calyceal diverticulum are outpouching from renal calyx or pelvis into the renal cortex lined by transitional cell epithelium. We report a case of 35 years old male with history of accidental fall from bike, who presented with persistent right loin pain and hematuria. CT Urogram showed multiple large right renal cysts (BOSNIAK II). Patient was planned laparoscopic renal cyst deroofing. Due to suspicion of calyceal diverticulum, an intraoperative Retrograde Pyelogram (RGP) was done which showed calyceal diverticulum. Laparoscopic calyceal diverticulotomy with closure of communication was done. If only a cyst deroofing was done considering the CT finding alone, it would have ended up in post-operative complication of urinoma which may require a re-surgery. This case report emphasizes the importance of anticipating calyceal diverticulum and intraoperative attempts in the form of doing RGP to identify calyceal diverticulum which mimic renal cyst regardless of CT finding in suspected cases. Keywords: Calyceal diverticulum; large renal cyst; retrograde pyelogram; laparoscopic calyceal; Diverticulotomy.

Highlights

Calyceal diverticulum are urine containing cavities in the renal parenchyma which communicate with the pelvicalyceal system by an infundibulum
Calyceal diverticulum can be diagnosed with delayed films in contrast CT by filling of contrast into the diverticulum
If the communicating neck is not patent, there will not be any reflux of contrast during CT imaging and it poses a diagnostic challenge in radiological diagnosis

Summary

INTRODUCTION

Calyceal diverticulum are urine containing cavities in the renal parenchyma which communicate with the pelvicalyceal system by an infundibulum. They are benign, usually asymptomatic and often found incidentally on radiological imaging. A thirty-five years old male presented to outpatient department with dull aching localized right loin pain for two weeks following a fall from bike. He had two episodes of total painless hematuria.

DISCUSSION

CONCLUSION