Calyceal diverticulum is a relatively uncommon cystlike lesion, often discovered incidentally during ultrasound examination of the kidneys. We found dyed urine excretion from the cyst, which confirmed the cyst as the calyceal diverticulum. Recent findings possible methods of treatment in calyceal diverticula are generally the same as in other abnormalities of the kidney. C, following percutaneous stone extraction, a nephrotomogram shows the absence of calculi. Hiremath 2 1 department of urology, kles kidney foundation, kle universitys jawaharlal nehru medical college, kles dr. Usually found in pairs on opposite sides of the bladder. Renal papillary and calyceal lesions at ct urography. The diverticulum may be congenital, secondary to trauma or a complication of previous surgery such as percutaneous nephrolithotomy pcnl. These diverticula are lined with transitional cell epithelium. A calyceal diverticulum is usually identified during urological investigation for haematuria or recurrent urinary tract infection.
Hydronephrosis and upper urinary tract obstruction. Caliceal diverticulum is a well recognized entity, usually noted incidentally on excretory urography ivp. Controversy exists over whether metabolic factors or urinary stasis predominate in the pathogenesis of calyceal diverticular calculi. T1 transitional cell carcinoma obstructing a calyceal diverticulum. Does a stone located in the calyceal diverticulum require intervention or can it be watched. Calyceal diverticulum was first described by rayer in 1841. They were first described by rayer in traitements des maladies des reins 1. Often found incidentally on radiological imaging, they are generally benign and usually asymptomatic, although complications include infection and stone formation. Computed tomography revealed perinephric extravasation of urine and bleeding inside the diverticulum.
I would suggest that you seek a comprehensive medical evalaution. We performed a study to better define the effects urinary stasis and metabolic abnormalities have in the pathogenesis of calyceal diverticular stones. Robotically assisted laparoscopic diverticulectomy was successfully performed and the patient discharged home the. Findings in keeping with calyceal diverticulum and stasis calculi. Urine formed in the kidney passes through a renal papilla at the apex into the minor calyx. Balloonlike growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia in older males. Discussion milk of calcium in a calyceal diverticulum or renal cyst can pose a diagnostic dilemma. The diverticulum is lined by transitional epithelium and surrounded by muscularis mucosae, communicating with the collecting system via a narrow isthmus or infundibulum. The management of calyceal diverticulum has evolved from an open surgical approach to a minimally invasive approach. A calyceal diverticulum can be complicated by renal colic renal stone, which was the cause of recurrent flank pain in this patient. Calyceal diverticulum of the kidney diagnostic imaging. Mullett calyceal diverticulum a mimic of different. Calyceal diverticula are rarely diagnosed in children.
Calyceal diverticulae are congenital smoothwalled, nonsecretory urotheliumlined cavities within the renal parenchyma that communicate with calyceal fornix through a diverticular neck. Get yourself in the hands of an expert or expertsasap. Calyceal diverticula are rare outpouchings of the upper collecting system lying within the renal parenchyma. Describe normal anatomy and anatomic variations of renal papillae and calyces that may simulate pathologic processes.
Clinical manifestation of a calyceal diverticular abscess. Percutaneous management of renal caliceal diverticular. Ultrasound demonstration of milk of calcium within a. The authors report that most calyceal diverticula become apparent at the time of ivu study, owing to their inherent connection with the collecting system.
One of my physicians performed an percutaneous nephrostolithotomy with removal of stone and a holmium laser and bugbee ablation of caliceal diverticulum with dilation of the infundibulum. Learn diverticulum with free interactive flashcards. Disease bioinformatics research of acquired calyceal diverticulum has been linked to diverticulum, kidney diseases, kidney calculi, cystic kidney diseases, pain. It is caused by incomplete obliteration of the vitelline duct and consists of a congenital sacculation of the antimesenteric border of the ileum. Calyceal diverticulum is filled with contrast material in the excretory phase if the infundibulum is patent. Calyceal diverticulum a mimic of different pathologies on. Because renal cysts are infrequently seen in fetuses, the differential diagnosis of a simple renal cyst is often overlooked when considering other pathologies such as hydronephrosis, multicystic dysplastic kidneys, wilms tumor, etc. Critical challenges of renal calculi in women medscape. Kidney, cyst cases, lectures, articles, cmes sonoworld. Our patient presented with hematuria and flank pain after an episode of blunt trauma.
The inaugural meeting of the southern african endourology society was held at the urological association of south africa congress in the drakensburg in august 2008. Milk of calcium is a fine colloidal suspension of precipitated calcium salts carbonate, phosphate and oxalate and may be radiopaque or radiolucent. They can mimic other renal cystic lesions and correct diagnosis can be difficult to establish. When it comes to treating calyceal diverticula, which is seen on fewer than 1 percent of intravenous urograms, many urologists have more questions than answers. Inorganicpsychogenic causes of ed previous urologic surgery urologic operations that have been reported to cause ed include. Rathaus et al described a series of 11 patients with calyceal diverticula. We present a case of a 45yearold female who experienced rupture of a right calyceal diverticulum caused by ureteroscopy. Calyceal diverticulum southern african endourology society. A, ivp shows calculi lying outside the collecting system, because no contrast enters the upper pole diverticulum. Does it depend if it is symptomatic and is this common.
Mar 28, 2007 calyceal diverticulum treatment published on wed mar 28, 2007 question. All patients enrolled underwent a complete medical history and physical examination, and patients with systemic disorders such as primary hyperparathyroidism, sarcoidosis, vitamin d excess, hyperthyroidism, or renal tubular acidosis were excluded from. The study of acquired calyceal diverticulum has been mentioned in research publications which can be found using our bioinformatics tool below. Irbapproved, prospective study of the pathogenesis of calyceal diverticular calculi. B, ct scan confirms the presence of stones within the diverticulum, which is situated anteriorly. The percutaneous approach is associated with the highest stone, symptom, and diverticulum free rates and is the optimal treatment for all but anteriorly located diverticula. Kidney stone disease, also known as nephrolithiasis or urolithiasis, is when a solid piece of material kidney stone develops in the urinary tract. Currently, the percutaneous, ureteroscopic and laparoscopic techniques are. Fifteen hours after the operation, she had severe right flank pain and a high fever 38. The doctor has noted that he is going to treat a patient using the ureteroscope to go up the ureter into the renal pelvis and drain the calyceal diverticulum on the right side. Percutaneous management of renal caliceal diverticular stones. Diagnosis is best made by intravenous urography or computed tomography urogram. The renal calyces are the most common location for asymptomatic urinary calculi, which are often incidentally discovered on an imaging study performed for another indication.
Calyceal diverticulum is a urinecontaining cavity within the renal parenchyma, communicating with the collecting system through a narrow channel. Tenyear experience of a tertiary care center with different techniques to deal with diverticula after stone extraction aneesh srivastava, saurabh sudhir chipde, anil mandhani, rakesh kapoor, mohammad s ansari. Last picture is noncontrast ct 1 year later shows that an extra calculus has developed. Would an mri be able to definitively tell the difference between a complex kidney cyst and a calyceal diverticulum.
A 40yearold primiparous woman developed the abscess at 23 weeks of gestation, with right flank pain and a 37. The calyceal diverticulum is an unusual and complex problem to manage, said marshall stoller, md, facs, professor of urology at the university of california, san francisco. A novel approach to the treatment of a calyceal diverticulum. A calyceal diverticulum is a urine containing outpouching of a calyx into the renal parenchyma, communicating with the pelvicaliceal system via a narrow neck 1,2. A calyceal diverticulum is a cystic cavity within the kidney that is lined by transitional epithelium and communicates with a calyx or less commonly with the renal pelvis through a narrow isthmus. There is no consensus regarding the cause of calyceal diverticula, although the majority of investigators have favored congenital over acquired origins. Connection between fluid collection and collecting system confirmed by imaging studies is the key diagnostic. It can be diagnosed as an incidental finding or can be symptomatic. Here we present the case of a calyceal diverticular abscess during pregnancy. Meckel diverticulum msd manual professional edition. Calyceal diverticulum a mimic of different pathologies on multiple imaging modalities calyceal diverticula are outpouchings of a renal calyx. She also sewed a councill catheter into place in the calyceal diverticulum, and placed a flexible nephroscope through the mouth of the diverticulum into the renal pelvis to inspect the kidney. Hydronephrosis means literally water inside the kidney and refers to the distension and dilation of the pyelocaliceal system. The term calyceal diverticulum or pyelocalyceal diverticulum refers to a urinecontaining cystic cavity within the renal parenchyma.
A symptomatic calyceal diverticulum is a rare entity. Calyceal diverticulum a mimic of different pathologies. This is the appearance of a calyceal diverticulum, which is a small outpouching or eventration of a calyx into the renal parenchyma. Caliceal diverticulum definition of caliceal diverticulum. Calyceal diverticulum definition of calyceal diverticulum.
Calyceal diverticulum is a relatively rare lesion that is usually asymptomatic but can assume clinical significance if drainage is impaired. Undetected calyceal diverticulum with perioperative ct ivp. Progressive contrast fillin with time corticomedullary phase, 10min excretory, 60min, 24hours. Experts to debate treatment options for upper pole. The present study reports a case of invasive urothelial carcinoma within a calyceal diver ticulum associated with renal stones. Calyceal diverticula are eventrations of the upper collecting system lying within the renal parenchyma. Jan 01, 2017 this group of patients were significantly more hypercalciuric, and their urine was found to be supersaturated with calcium oxalate.
Large left renal cystic lesion with dependent calculus. Kidney stones typically form in the kidney and leave the body in the urine stream. The upper calyx is the one that is most affected 70%. Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Calculi or layered dependent milk of calcium complicating a calyceal diverticulum appear echogenic on ultrasound, but only the former will cast an acoustic shadow. Transitional cell carcinoma obstructing a calyceal. Prabhakar kore hospital and medical research centre, belgaum, karnataka, india 2 department of biotechnology and microbiology, karnatak university, dharwad, karnataka, india. If the diverticulum communicates with the renal pelvis, from the online textbook of urology by d. This novel approach has not previously been described in the pediatric population.
On nephrographic phase contrastenhanced ct, a calyceal diverticulum will have an appearance similar to that of a simple cyst. Meckel diverticulum is a true diverticulum and is the most common congenital anomaly of the gi tract, occurring in about 2% of people. T1 renal papillary and calyceal lesions at ct urography. The imaging appearances of calyceal diverticula complicated. Multiple procedures lead to complex coding published on fri may 07, 2004 question. They are usually connected by a narrow channel to the renal pelvis, as seen in the ivp image above. A urothelial neoplasm involving the renal calyces may be seen as a subtle enhancing mass at early postcontrast ct and as a filling defect within the calyces in the excretory phase. These often contain stones, however, carcinoma within a caly ceal diverticulum is uncommon. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. A caliceal diverticulum is a cystic cavity of the kidney, which is lined with urothelium and has or had a connection to a renal calyx.
As in our case, a calyceal diverticulum may be seen on bone scan as an area of focal uptake in the region of the kidney, usually the upper pole 12. The minor calyces surround the apex of the renal pyramids. It is associated with stone formation in onethird of cases. Calyceal diverticula are outpouchings of a renal calyx. Lastly, laparoscopy is reserved for large, anteriorly positioned diverticula or diverticula that fail endourological management. We analyse and summarise the literature with a focus on recent advances in the management of calyceal diverticula and discuss the advantages and disadvantages of each surgical technique. Calyceal diverticula are congenital, nonsecretory abnormalities in which the transitional celllined cavity communicates with the renal collecting system. How to prevent stone recurrence in calyceal diverticulum. In calyceal diverticulum, tracer may accumulate in the diverticulum, rather than being excreted, and thus be detected by the gamma camera. The patient was discharged on day 10 after nephrostomy and was started on oral cefaclor 0. Transitional cell carcinoma obstructing a calyceal diverticulum. Calyceal diverticulum mimicking simple parapelvic cyst. Answers from trusted physicians on calyceal diverticulm. T1 ultrasound demonstration of milk of calcium within a calyceal diverticulum.
The authors found that aspirate from the calyceal diverticulum, however, contained a lower supersaturation of calcium oxalate compared to aspirates from the renal pelvis of the same patient. Choose from 99 different sets of diverticulum flashcards on quizlet. Three patients are presented with unusual complications directly referable to a calyceal diverticulum. Calyceal diverticula are rare entities that can pose a significant challenge when it comes to their management. Often found incidentally on radiological imaging, they are generally benign and usually asymptomatic, although complications include. Management of calyceal diverticular stones using ultramini.
The renal calyces are chambers of the kidney through which urine passes. Jul 23, 20 does a stone located in the calyceal diverticulum require intervention or can it be watched. Calyceal diverticula, also known as pyelocalyceal diverticula are congenital outpouchings from the renal calyx or pelvis into the renal cortex. A calyceal diverticulum is a urinecontaining cystic cavity communicating with the collecting system via a narrow isthmus. Mar 04, 20 this feature is not available right now. Hydronephrosis is caused by an obstruction of the urine flow from the kidney. Clinical manifestation of a calyceal diverticular abscess in. Ultrasound demonstration of milk of calcium within a calyceal.
We report a case where the calyceal diverticulum was not detected on preoperatively despite imaging with ct ivp. Management of the bladder and calyceal diverticulum. What is calyceal diverticulum in the right kidney mean. The pathogenesis of calyceal diverticular calculi johns. Rupture of a calyceal diverticulum secondary to ureteroscopy. Surgical management of the calyceal diverticulum request. T2 unusual presentation as a peripheral cystic mass. It is important to find the exact location of the stonebearing diverticulum and various imaging techniques may be used for this purpose. The percutaneous approach is associated with the highest stone, symptom, and diverticulumfree rates and is the optimal treatment for all but anteriorly located diverticula. Review examples of renal papillary and calyceal lesions and their appearance at ct urography.
We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. The diverticulum is lined by transitional epithelium and surrounded by muscularis mucosae, communicating with the collecting system via a narrow isthmus or infundibulum 1. It is a cavity lined with transitional cells that most commonly originates as a narrow isthmus from the fornix of an otherwise normal minor calix fig. Discuss ct urographic techniques that can influence detection of subtle papillary and calyceal lesions. Calyceal diverticula might be diagnosed as an incidental finding or can be symptomatic. Our report details a robotically assisted laparoscopic calyceal diverticulectomy in a 14 year old female.
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