Radiological evaluation of a calyceal diverticulum presenting with hematuria

Cover Image

Cite item

Full Text

Abstract

Calyceal diverticula, also known as pyelogenic cysts, are a relatively uncommon condition, which is usually asymptomatic and incidentally diagnosed during routine imaging. In some cases, they may lead to concerning symptoms such as hematuria and flank pain, mimicking a renal tumor. In this case report, the patient suffered from hematuria that was initially suspected as a renal malignancy but was ultimately attributed to a calyceal diverticulum. The presented case allows evaluating one of the rarest and underestimated causes of hematuria and describes the main imaging features of calyceal diverticula. In particular, ultrasonography, computed tomography urography, dual-energy computed tomography, and magnetic resonance urography were performed. Subsequently, this case report also serves an educational purpose.

About the authors

Federica Masino

Foggia University School of Medicine

Email: federicamasino@gmail.com
ORCID iD: 0009-0004-4289-3289

MD

Italy, Foggia

Manuela Montatore

Foggia University School of Medicine

Email: manuela.montatore@unifg.it
ORCID iD: 0009-0002-1526-5047

MD

Italy, Foggia

Laura Eusebi

Carlo Urbani Hospital

Email: lauraeu@virgilio.it
ORCID iD: 0000-0002-4172-5126

MD

Italy, Jesi

Rossella Gifuni

Foggia University School of Medicine

Email: rossella.gifuni@gmial.com
ORCID iD: 0009-0009-9679-3861

MD

Italy, Foggia

Gianmichele Muscatella

Foggia University School of Medicine

Email: muscatella94@gmail.com
ORCID iD: 0009-0004-3535-5802

MD

Italy, Foggia

Marina Balbino

Foggia University School of Medicine

Email: marinabalbino93@gmail.com
ORCID iD: 0009-0009-2808-5708

MD

Italy, Foggia

Giuseppe Sortino

Carlo Urbani Hospital

Email: giuseppesortino@live.it

MD

Italy, Jesi

Lucia Pitoni

Carlo Urbani Hospital

Email: lucia.pitoni22@gmail.com
ORCID iD: 0000-0002-8419-090X

MD

Italy, Jesi

Giuseppe Guglielmi

Foggia University School of Medicine; Dimiccoli Hospital; IRCCS Casa Sollievo della Sofferenza Hospital

Author for correspondence.
Email: giuseppe.guglielmi@unifg.it
ORCID iD: 0000-0002-4325-8330

MD, Professor

Italy, Foggia; Barletta; San Giovanni Rotondo

References

  1. Zhao Y, Zhang R, Yun Y, et al. A case report of renal calyceal diverticulum with hypertension in children and review of literature. BMC pediatrics. 2022;22(1):35. doi: 10.1186/s12887-021-03081-5
  2. Zhang R, Shen W, Li X, et al. A Petal-like Calyceal Diverticulum. Urology. 2015;86(6):e31–e32. doi: 10.1016/j.urology.2015.09.003
  3. Zhang Z, Zhang Y, Wang X, et al. Challenges in the diagnosis of calyceal diverticulum: A report of two cases and review of the literature. Journal of X-ray science and technology. 2020;27(6):1155–1167. doi: 10.3233/XST-190549
  4. Waingankar N, Hayek S, Smith AD, Okeke Z. Calyceal diverticula: a comprehensive review. Reviews in urology. 2014;16(1):29–43.
  5. Kurkov AV, Pominalnaya VM, Nechay VV, et al. A Case Report of Calyceal Diverticulum: Differential Diagnosis for Organ-Preserving Operations. Frontiers in surgery. 2021;8:731796. doi: 10.3389/fsurg.2021.731796
  6. Montatore M, Muscatella G, Eusebi L, et al. Current Status on New Technique and Protocol in Urinary Stone Disease. Current Radiology Reports. 2023;11:161–176. doi: 10.1007/s40134-023-00420-5
  7. Eusebi L, Masino F, Gifuni R, et al. Role of Multiparametric-MRI in Bladder Cancer. Current Radiology Reports. 2023;11:69–80. doi: 10.1007/s40134-023-00412-5

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Ultrasound examination revealed a large, heterogeneous formation, predominantly anechoic, with rounded, clear boundaries, located in the middle-lower part of the left kidney. The largest diameter was 6.38 cm.

Download (92KB)
Indexing metadata
3. Fig. 2. Axial sections, results of computed tomographic urography: a — without contrast, during scanning there were no signs of lithiasis in both kidneys, the formation in the left kidney was hypodense with a tomographic density corresponding to fluid (in Hounsfield units); b — in the arterial phase, during scanning a slight increase in the density of the cyst-like cavity was noted; c — in the excretory phase, during scanning there was contrast enhancement of the cavity walls, with gradual filling of the cavity with contrast agent.

Download (172KB)
Indexing metadata
4. Fig. 3. Processed images obtained by dual-energy computed tomography, coronal plane. In the color-coded iodine distribution maps (a, b), iodine uptake by the excretory system, including the calyceal diverticulum, is represented in bright yellow. In panel b, there is no iodine signal in the cyst area.

Download (304KB)
Indexing metadata
5. Fig. 4. Magnetic resonance urography, axial sections: a — a hyperintense formation is visualized on the T2-weighted image; b — a hyperintense formation and renal pelvis are visualized on the T1-weighted image in fat-suppression mode after the introduction of a contrast agent in the delayed phase; c — the formation and the excretory system are visualized with the same intensity on the in-phase image; d — diffusion limitation is absent on the diffusion-weighted image with a high b-value.

Download (262KB)
Indexing metadata
6. Fig. 5. Magnetic resonance urography, coronal sections, T1-weighted images in fat-suppressed mode in the delayed phase after the administration of a contrast agent. Two lesions located in the upper pole of both kidneys are cysts. (In the two subsequent images, the diverticulum was visualized filled with contrast agent, and its funnel-shaped channel communicated with the renal pelvis and calyces).

Download (224KB)
Indexing metadata

Copyright (c) 2024 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).