Diagnostic dilemma: calyceal diverticulum vs complicated cyst

A Petal-like Calyceal Diverticulum

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. They are usually single cystic lesions accompanied by stones inside them and located in the upper pole calyces. We present a case containing a petal-like cystic lesion with multiple septa in the lower pole of the left kidney, which was confirmed as calyceal diverticulum by computed tomography urography and intraoperative findings.

Calyceal diverticulum of the kidney - diagnostic imaging dilemma in pediatric patients - case report

Background

Calyceal diverticula are rarely diagnosed in children. They can mimic other renal cystic lesions and correct diagnosis can be difficult to establish. Connection between fluid collection and collecting system confirmed by imaging studies is the key diagnostic finding.

Case Report

In this report we present a case of pediatric patient with calyceal diverticulum, with initial ultrasonographic diagnosis of simple renal cyst. Final diagnosis was established after extended diagnostics following infection of a fluid collection.

Conclusions

1. Differential diagnosis of well-circumscribed solitary renal fluid collections in children should include particularly: simple cyst, calyceal diverticulum and the first demonstration of ADPKD. 2. Diagnosis of calyceal diverticulum should be confirmed by contrast studies. 3. Standard management of calyceal diverticula in children includes ultrasonographic follow-up and conservative treatment and rarely requires surgical intervention.

Caliceal diverticulum in pediatric patients: the spectrum of imaging findings

BACKGROUND

Caliceal diverticulum (CD) is uncommon in children. As compared to adults, most children with CD are symptomatic. Common complications include stone formation and infection. Correct diagnosis of CD is important for guiding management.

OBJECTIVE

To identify imaging findings at diagnosis and follow-up in pediatric patients with CD.

MATERIALS AND METHODS

We identified all patients from 2003 to 2010 with a diagnosis of CD. We reviewed presenting symptoms, underlying diseases, complications, management, and all pertinent radiological examinations.

RESULTS

Twenty-four patients (2.6 to 18.5 years old, 11 females) had CD. Urinary tract infection was the most common (n = 8) presentation. Diagnosis of CD was based on delayed post-contrast CT in 79% of patients with only one false-negative CT. Most patients (n = 20) had a single CD; others had either 2 CDs (n = 2) or multiple CDs (n = 2). CD diameter ranged from 1.0 to 18.3 cm and grew in five of nine patients who had follow-up studies. Seven patients developed stone in the CD. Fifteen patients (63%) underwent a surgical procedure.

CONCLUSIONS

CD is commonly solitary, often grows with time and may mimic other diagnoses, including simple cyst, complex cyst and polycystic kidney disease. Delayed postcontrast CT is highly sensitive in diagnosing CD.

The imaging appearances of calyceal diverticula complicated by uroliathasis

The presence of diverticula arising from the calyceal system is a relatively uncommon urological problem, occurring with an incidence of 2.1-4.5 per 1000 intravenous urogram (IVU) examinations. While the incidence of calyceal diverticula is low, the frequency of stone formation within them is high. We describe the aetiology and clinical presentation and describe the role of imaging with ultrasound, intravenous and retrograde pyelography and CT in diagnosis and planning treatment. We also describe the potential of fluid-sensitive magnetic resonance imaging techniques as a radiation-free alternative to the use of more conventional modalities, such as intravenous urography and retrograde pyelography, in delineating the anatomy of calyceal diverticula before surgical and radiological intervention especially in young patients and pregnant women.