Calyceal diverticulum ivp booklet

Prabhakar kore hospital and medical research centre, belgaum, karnataka, india 2 department of biotechnology and microbiology, karnatak university, dharwad, karnataka, india. Computed tomography urography for diagnosis of calyceal. Only one report to date has addressed pregnancy complicated by a calyceal diverticular abscess 4, and management is therefore not well established. In some cases, the divericulum might be misdiagnosed as a complex cyst. Renal calyx kidney, with major and minor calyces labeled near bottom. Mar 28, 2007 calyceal diverticulum treatment published on wed mar 28, 2007 question. Eau pocket guidelines 2012 free ebook download as pdf file. Calyceal diverticulum a mimic of different pathologies on multiple imaging modalities calyceal diverticula are outpouchings of a renal calyx. Surgical management of the calyceal diverticulum request. Irbapproved, prospective study of the pathogenesis of calyceal diverticular calculi. Renal papillary and calyceal lesions may cause hematuria and can be associated with complications such as urinary tract infection. On ivu, calyceal diverticula have the appearance of opacified cystic cavities, which communicate with the renal collecting system. We initially performed a cystoscopy and retrograde pyelogram.

It can be diagnosed as an incidental finding or can be symptomatic. Calyceal diverticula are rare entities that can pose a significant challenge when it comes to their management. This is the appearance of a calyceal diverticulum, which is a small outpouching or eventration of a calyx into the renal parenchyma. We report a rare case of a disappearing cystic mass of the kidney. The pathogenesis of calyceal diverticular calculi johns. Renal calyceal diverticulum is a relative rare renal congenital abnormalities. Calculi or layered dependent milk of calcium complicating a calyceal diverticulum appear echogenic on ultrasound, but only the former will cast an acoustic shadow. Calyceal diverticula are eventrations of the upper collecting system lying within the renal parenchyma. Ivp demonstrating blush of ivp dye into diverticulum. Findings in keeping with calyceal diverticulum and stasis calculi. These nonsecretory outpouchings are lined by transitional cell epithelium and communicate with the main collecting system via a narrow channel, allowing for passive filling with urine. On nephrographic phase contrastenhanced ct, a calyceal diverticulum will have an appearance similar to that of a simple cyst. 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.

Management of calyceal diverticular stones using ultramini. Undetected calyceal diverticulum with perioperative ct ivp. Mullett calyceal diverticulum a mimic of different. B, ivp confirms the stone lies outside the collecting system, within a calyceal diverticulum. It is important to find the exact location of the stonebearing diverticulum and various imaging techniques may be used for this purpose.

C, pnl was performed with puncture directly into the calyceal diverticulum. A range of causes of urinary bladder diverticula are described. It is formed by early contrast opacification of the dilated collecting ducts and ducts of bellini with the characteristic shape as a result of the associate. C, following percutaneous stone extraction, a nephrotomogram shows the absence of calculi. Fifteen hours after the operation, she had severe right flank pain and a high fever 38. Calyceal diverticula, also known as pyelocalyceal diverticula are congenital. We present a case of a 45yearold female who experienced rupture of a right calyceal diverticulum caused by ureteroscopy. Intravenous urogram ivu and retrograde studies can be required to confirm diagnosis.

Percutaneous holmium laser fulguration of calyceal diverticula. 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. After placing guidewires, the tract was dilated using the x. A, ivp shows calculi lying outside the collecting system, because no contrast enters the upper pole diverticulum. Robotically assisted laparoscopic diverticulectomy was successfully performed and the patient discharged home the.

Manifestations of diverticula include hematuria, signs of infection especially chronic or recurrent urinary tract infections or. Connection between fluid collection and collecting system confirmed by imaging studies is the key diagnostic. Although most are asymptomatic, occasionally there are complications of recurrent infection, hematuria. Calyceal diverticulum a mimic of different pathologies on. Balloonlike growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia in older males.

Calyceal diverticulum a mimic of different pathologies. B, ct scan confirms the presence of stones within the diverticulum, which is situated anteriorly. Hiremath 2 1 department of urology, kles kidney foundation, kle universitys jawaharlal nehru medical college, kles dr. Percutaneous treatment of calyceal diverticula, infundibular stenosis, and simple renal cysts. 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. The imaging appearances of calyceal diverticula complicated by. Our report details a robotically assisted laparoscopic calyceal diverticulectomy in a 14. The authors report that most calyceal diverticula become apparent at the time of ivu study, owing to their inherent connection with the collecting system. Usually found in pairs on opposite sides of the bladder. T1 transitional cell carcinoma obstructing a calyceal diverticulum.

The diverticulum is lined by transitional epithelium and surrounded by muscularis mucosae, communicating with the collecting system via a narrow isthmus or infundibulum 1. 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. They can become symptomatic when urinary stasis in the blind cyst leads to infection or calculi formation 5. Pelvicalyceal system and ureter over the past several years, excretory urography ivp has been essentially replaced by computed tomography urography ctu for evaluation of the urinary tract. Lastly, laparoscopy is reserved for large, anteriorly positioned diverticula or diverticula that fail endourological management.

Choose from 99 different sets of diverticulum flashcards on quizlet. The term calyceal diverticulum or pyelocalyceal diverticulum refers to a urinecontaining cystic cavity within the renal parenchyma. In calyceal diverticulum, tracer may accumulate in the diverticulum, rather than being excreted, and thus be detected by the gamma camera. Learn more about acquired calyceal diverticulum from related diseases, pathways, genes and ptms with the novus bioinformatics tool. Often found incidentally on radiological imaging, they are generally benign and usually asymptomatic, although complications include infection and stone formation. A photopenic area in the right upper pole is seen in the early phase image which shows gradual radiotracer accumulation and. Would an mri be able to definitively tell the difference between a complex kidney cyst and a calyceal diverticulum. 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. It was initially diagnosed as bosniak class 2 cyst. The management of calyceal diverticulum has evolved from an open surgical approach to a minimally invasive approach. Calyceal diverticulum is a urinecontaining cavity within the renal parenchyma, communicating with the collecting system through a narrow channel.

The calyceal crescent sign dunbar crescents refers to the early intravenous pyelogram ivp appearance of markedly dilated renal calyces. Nonneoplastic disorders of the renal pelvis and ureter. Diverticulum size ranging from 12 to 37 mm was successfully obliterated when complete stone was removed. Ultrasonography is able to detect milk of calcium layering within a diverticulum. Progressive contrast fillin with time corticomedullary phase, 10min excretory, 60min, 24hours. Kidney stones typically form in the kidney and leave the body in the urine stream. Our patient presented with hematuria and flank pain after an episode of blunt trauma. Jan 01, 2017 this group of patients were significantly more hypercalciuric, and their urine was found to be supersaturated with calcium oxalate. Management of the bladder and calyceal diverticulum.

Calyceal diverticulum mimicking simple parapelvic cyst. A, calyceal diverticulum detected by tc99m dtpa diuretic renal scan. We suggest methods to deal with diverticulum after stone removal. We report a case where the calyceal diverticulum was not detected on preoperatively despite imaging with ct ivp. The diverticulum may be congenital, secondary to trauma or a complication of previous surgery such as percutaneous nephrolithotomy pcnl. Three patients are presented with unusual complications directly referable to a calyceal diverticulum. 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. Acquired diverticula are more common, usually occurring the context of a trabeculated bladder, resulting from chronic bladder outlet obstruction. 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. Bladder diverticulum diverticula are often an incidental finding on imaging investigations, including ultrasound, ct, mri and ivu. Transitional cell carcinoma obstructing a calyceal. Calyceal diverticula are congenital, nonsecretory abnormalities in which the transitional celllined cavity communicates with the renal collecting system. Calyceal diverticula, also known as pyelocalyceal diverticula are congenital outpouchings from the renal calyx or pelvis into the renal cortex.

Small left renal cystic lesion with posterior calcifications. 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. Mar 04, 20 this feature is not available right now. Renal papillary and calyceal lesions at ct urography. We performed a study to better define the effects urinary stasis and metabolic abnormalities have in the pathogenesis of calyceal diverticular stones. Caliceal diverticulum is a well recognized entity, usually noted incidentally on excretory urography ivp.

A, a 1cm calculus is present in the upper pole of the patients right kidney. Calyceal diverticula can cause pain, hematuria, urinary tract infection, and damage to surrounding renal parenchyma due to compression and may require surgical intervention. Jul 23, 20 does a stone located in the calyceal diverticulum require intervention or can it be watched. 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. Pdf potential role of tc99m dtpa diuretic renal scan in. Pdf calyceal diverticula are rarely diagnosed in children. The differential diagnosis is a calyceal diverticulum or hydrocalyx, both of which communicate with the collecting system and in which the fluid should enhance on either ivp or ct. Careful windowing shows that those calcifications are likely dependent calculi instead. Our report details a robotically assisted laparoscopic calyceal diverticulectomy in a 14 year old female.

They can mimic other renal cystic lesions and correct diagnosis can be difficult to. Large left renal cystic lesion with dependent calculus. Kidney, cyst cases, lectures, articles, cmes sonoworld. 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. The patient presented with right flank pain and she had an abdominal xray that showed multiple radioopaque stones overlying right kidney and confirmed on ultrasound as a calyceal diverticulum.

Learn diverticulum with free interactive flashcards. A calyceal diverticulum is a urinecontaining cystic cavity communicating with the collecting system via a narrow isthmus. Calyceal diverticula are outpouchings of 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. Calyceal diverticula require treatment when they harbor stones or infection. Calyceal diverticula are rare outpouchings of the upper collecting system lying within the renal parenchyma. An image showing just the pelvis and calices of the kidneys, with the rest of the kidney removed, from a dissected cow and seal specimen. Discuss ct urographic techniques that can influence detection of subtle papillary and calyceal lesions. The present study reports a case of invasive urothelial carcinoma within a calyceal diver ticulum associated with renal stones. They can mimic other renal cystic lesions and correct diagnosis can be difficult to establish. Kidney stone disease, also known as nephrolithiasis or urolithiasis, is when a solid piece of material kidney stone develops in the urinary tract. Critical challenges of renal calculi in women medscape. Surgical management of the calyceal diverticulum request pdf. If the diverticulum communicates with the renal pelvis, from the online textbook of urology by d.

A calyceal diverticulum is usually identified during urological investigation for haematuria or recurrent urinary tract infection. This would suggest this lesion being a calyceal diverticulum. 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. Calyceal diverticulum is a relatively uncommon cystlike lesion, often discovered incidentally during ultrasound examination of the kidneys. Renal calyceal diverticulum is a cystic cavity filled with urine within the renal parenchyma. Currently, the percutaneous, ureteroscopic and laparoscopic techniques are.

Challenges in the diagnosis of calyceal diverticulum. Multiple procedures lead to complex coding published on fri may 07, 2004 question. A calyceal diverticulum complicated by dependent calculi appears echogenic on ultrasound with acoustic shadows. B intravenous pyelogram demonstrating stones within upper pole caliceal diverticulum. A novel approach to the treatment of a calyceal diverticulum. Does it depend if it is symptomatic and is this common. These often contain stones, however, carcinoma within a caly ceal diverticulum is uncommon.

Calyceal diverticulum of the kidney diagnostic imaging. Read computed tomography urography for diagnosis of calyceal diverticulum complicated by urolithiasis. Ivp shows i that the diverticulum is located around the calyx with compression and deformity of the pelvis and calyx, ii hydronephrosis with urinary tract obstruction such as bluntness or disappearance of the calyceal angle, and iii dilatation of the pelvis and calyx. The accuracy and the effect of abdominal compression and prolongation of acquisition delay, urology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. There is no consensus regarding the cause of calyceal diverticula, although the majority of investigators have favored congenital over acquired origins. Historically, symptomatic caliceal diverticula were managed. These diverticula are lined with transitional cell epithelium. This novel approach has not previously been described in the pediatric population. Eau pocket guidelines 2012 radiation therapy metastasis. Here we present the case of a calyceal diverticular abscess during pregnancy. Calyceal diverticulum is a relatively rare lesion that is usually asymptomatic but can assume clinical significance if drainage is impaired. Review examples of renal papillary and calyceal lesions and their appearance at ct urography.

Computed tomography revealed perinephric extravasation of urine and bleeding inside the diverticulum. Associated pelvicalyceal dilatation can be seen with variable degree. Invasive urothelial carcinoma within a calyceal diverticulum. One patient had residual stonerecurrence 8 mm with persistent diverticula 25 mm cavity decrease to 18 mm on followup ivp.

The diverticulum is lined by transitional epithelium and surrounded by muscularis mucosae, communicating with the collecting system via a narrow isthmus or infundibulum. What is calyceal diverticulum in the right kidney mean. Last picture is noncontrast ct 1 year later shows that an extra calculus has developed. Calyceal diverticulum is filled with contrast material in the excretory phase if the infundibulum is patent.

Milk of calcium is a fine colloidal suspension of precipitated calcium salts carbonate, phosphate and oxalate and may be radiopaque or radiolucent. Calyceal diverticulum is believed to be a congenital abnormality in which a urinefilled urotheliallined outpouching is connected to the intrarenal collecting system by a narrow isthmus. Pdf calyceal diverticulum of the kidney diagnostic imaging. Calyceal diverticula are relatively uncommon tiny cystlike outpouchings communicating with the kidney collecting system and containing urine, often discovered incidentally during imaging examinations. A 40yearold primiparous woman developed the abscess at 23 weeks of gestation, with right flank pain and a 37. With the refinement of the techniques for ctu and increasing resolution of multidetector ct machines, it appears that virtually all lesions of the calyces, renal pelves, and ureters. Controversy exists over whether metabolic factors or urinary stasis predominate in the pathogenesis of calyceal diverticular calculi. Recent findings possible methods of treatment in calyceal diverticula are generally the same as in other abnormalities of the kidney. Attempt the first test of book 1 in the manner you want and do. Rathaus et al described a series of 11 patients with calyceal diverticula. In this online presentation, papillary or calyceal lesions, including papillary necrosis, medullary sponge kidney, renal tubular ectasia, calyceal diverticulum, pyelitis, pyelonephritis, forniceal or calyceal. Rupture of a calyceal diverticulum secondary to ureteroscopy. Discussion milk of calcium in a calyceal diverticulum or renal cyst can pose a diagnostic dilemma.

On ivp, the ureter is dilated predominantly in its distal part. This confirmed a neck of communication between the right collecting system and the large calyceal diverticulum. 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. They are usually connected by a narrow channel to the renal pelvis, as seen in the ivp image above. T2 unusual presentation as a peripheral cystic mass. Describe normal anatomy and anatomic variations of renal papillae and calyces that may simulate pathologic processes. The imaging appearances of calyceal diverticula complicated. Clinical manifestation of a calyceal diverticular abscess in. Calyceal diverticula are rarely diagnosed in children. It is congenital outpouchings of the renal calyx and communicate with the main collecting system via a narrow channel. The natural history of caliceal diverticula in children is unknown.

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