An intravenous pyelogram revealed a duplicated collecting system with a probable communication between the lower pole and a calyceal diverticulum see fig. We suggest methods to deal with diverticulum after stone removal. The imaging appearances of calyceal diverticula complicated. A calyceal diverticulum can be complicated by renal colic renal stone, which was the cause of recurrent flank pain in this patient. Connection between fluid collection and collecting system confirmed by imaging studies is the key diagnostic. Urine formed in the kidney passes through a renal papilla at the apex into the minor calyx. Calyceal diverticula are rarely diagnosed in children. Caliceal diverticulum cd is an uncommon disorder, in which a urinefilled cavity is connected to the renal calyx or the pelvis by a narrow or stenotic isthmus. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Renal papillary necrosis refers to ischemic necrosis of the renal papillae. 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. Renal papillary necrosis radiology reference article. Calyceal diverticulum is a urinecontaining cavity within the renal parenchyma communicating with the collecting system through a narrow channel and is lined by transitional epithelium.
A postoperative ivp at 12 months in the second patient showed significant reduction of the calyceal diverticulum without evidence of stones. Management of calyceal diverticular stones using ultramini. Calyceal diverticulum mimicking simple parapelvic cyst. Last picture is noncontrast ct 1 year later shows that an extra calculus has developed. The stagnant content irritates the mucous membrane of the diverticulum and becomes infected. The lesion persisted in 3 patients with an upper, 2 with a mid and 1 with a lower caliceal diverticulum. C, following percutaneous stone extraction, a nephrotomogram shows the absence of calculi. Manifestations of diverticula include hematuria, signs of infection especially chronic or recurrent urinary tract infections or. A 40yearold primiparous woman developed the abscess at 23 weeks of gestation, with right flank pain and a 37. Diagnosis is suspected on ultrasonography, and confirmed by computed tomography. Diagnosis is best made by intravenous urography or computed tomography. 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.
Kidney stones typically form in the kidney and leave the body in the urine stream. Management of the bladder and calyceal diverticulum. Morgan department of radiology and radiological science1 and departments of pathology and urology2 johns hopkins university, school. Bladder and calyceal diverticula are rare clinical entities in the pediatric population. The left ureterocele and stone of calyceal diverticulum in. While the incidence of diverticula is low, the frequency of stone formation is high due to urinary stasis. Mar 04, 20 ct of calyceal abnormalities in the kidney. Renal calyceal diverticulum is a relative rare renal congenital abnormalities. Irbapproved, prospective study of the pathogenesis of calyceal diverticular calculi. The goal of the management of calyceal diverticular calculi is the complete removal of stone and dilation of the diverticular infundibulum. This is the appearance of a calyceal diverticulum, which is a small outpouching or eventration of a calyx into the renal parenchyma. The diagnosis is made with certainty in the excretory phase when the cystic structure fills with contrast material due to communication with the collecting system, and layering of contrast material is seen within. Three patients are presented with unusual complications directly referable to a calyceal diverticulum.
Diagnosis is best made by intravenous urography or computed tomography urogram. 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. It is associated with stone formation in onethird of cases. Nonneoplastic disorders of the renal pelvis and ureter. Calyceal diverticulum of the kidney diagnostic imaging. Although the causes of renal calyceal cysts have not yet been clearly established, few studies have reported the possibility of congenital or acquired renal calyceal diverticula progressing to renal calyceal cysts. A postoperative ivp at 12 months in the second patient showed significant reduction of the calyceal diverticulum without evidence of. In this online presentation, papillary or calyceal lesions, including papillary necrosis, medullary sponge kidney, renal tubular ectasia, calyceal diverticulum, pyelitis, pyelonephritis, forniceal or calyceal. Calyceal diverticulum is filled with contrast material in the excretory phase if the infundibulum is patent. A novel approach to the treatment of a calyceal diverticulum. The pathogenesis of calyceal diverticular calculi johns. They can mimic other renal cystic lesions and correct diagnosis can be difficult to establish. Diverticulum size ranging from 12 to 37 mm was successfully obliterated when complete stone was removed.
Request pdf caliceal diverticulum and hydrocalyx laparoscopic management laparoscopic ablation of calyceal diverticula or hydrocalyces is different than other minimally invasive options for. Calyceal or ureteral obstruction by sloughed papillae manifest with flank pain, hematuria and varying degrees of renal impairment. Renal calyceal diverticulum is congenital outpouchings of the renal calyx and. In three patients, urine was sampled directly from the diverticulum for metabolic studies.
A caliceal diverticulum is an outpouching of the renal collecting system, which usually protrudes into the parenchyma of the kidney. She also sewed a councill catheter into place in the calyceal diverticulum, and placed a flexible nephroscope through the mouth of the diverticulum. Management of stone in calyceal diverticulum by flexible ureteroscopy, talk by dr. Mobile calculi and milk of calcium are characteristic. 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. Calyceal calculi are aggregations in either the minor or major calyx, parts of the kidney that pass urine into the ureter the tube connecting the kidneys to the urinary bladder. Calyceal diverticula are outpouchings of renal calyces or even renal pelvis pelvi calyceal diverticula into the renal cortex connected by narrow neck. They can become symptomatic when urinary stasis in the blind cyst leads to infection or calculi formation 5. The renal calyces are chambers of the kidney through which urine passes. Findings in keeping with calyceal diverticulum and stasis calculi.
Final diagnosis milk of calcium in renal diverticulum discussion milk of calcium in a calyceal diverticulum or renal cyst can pose a diagnostic dilemma. Calyceal diverticuli are characteristically drained by a narrow connection to the collecting. Calyceal diverticula might be diagnosed as an incidental finding or can be symptomatic. Large left renal cystic lesion with dependent calculus. 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. One patient had residual stonerecurrence 8 mm with persistent diverticula 25 mm cavity decrease to 18 mm on followup ivp. Retrograde intrarenal surgery in atretic calyceal diverticular stone, a.
For the first patient, ivp performed at 2, 11, and 24 months postoperatively showed absence of stones and significant reduction in the size of the calyceal diverticulum figure 1b. Although the incidence of calyceal diverticula is low, the incidence of stone formation within them is relatively high and occurs in up to 50% of cases 2, 10. Here we present the case of a calyceal diverticular abscess during pregnancy. It is lined with nonsecretory transitional epithelium and filled by urine through the adjacent collecting system. Progressive contrast fillin with time corticomedullary phase, 10min excretory, 60min, 24hours. 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. Renal calyceal diverticulum is a cystic cavity filled with urine 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. Stones can be found in up to 50% of calyceal diverticula, although, over the. Retrospective analysis of ultrasoundguided flexible.
Laparoscopic and robotic calyceal diverticulectomy. Caliceal diverticulum is a well recognized entity, usually noted incidentally on excretory urography ivp. Retrospective analysis of ultrasoundguided flexible ureteroscopy in the management of calyceal diverticular calculi. Diverticulum article about diverticulum by the free dictionary.
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. It can be diagnosed as an incidental finding or can be symptomatic. While the incidence of calyceal diverticula is low, the frequency of stone. The majority of cases are asymptomatic and discovered. Calyceal diverticula are congenital, nonsecretory abnormalities in which the transitional celllined cavity communicates with the renal collecting system. Calyceal diverticulum is a relatively uncommon cystlike lesion, often discovered incidentally during ultrasound examination of the kidneys. Several diagnostic clues that could prove useful in the detection of calyceal diverticula are discussed, as are various management options. Although most are asymptomatic, occasionally there are complications of recurrent infection, hematuria, and symptomatic calculi. A diverticulum containing milk of calcium appears as a semilunar density with a fluidcalcium level at the upper margin that changes position on upright or lateral decubitus radiographs.
It is important to find the exact location of the stonebearing diverticulum and various imaging techniques may be used for this purpose. Surgical management of the calyceal diverticulum request pdf. In general is an abnormal outpouching, most commonly seen in the colon. The urinary stone risk parameters of the patients with calyceal diverticular stones tic sf were similar to those of a wellcharacterized cohort of calcium oxalate stone formers caox sf. Treatment options for symptomatic, stonebearing, caliceal diverticula include shockwave lithotripsy swl, ureteroscopy, percutaneous nephrostolithotomyablation, and laparoscopic unroofing. In the meanwhile, ivp and ct scan revealed that a ureterocele was located in the left ureterovesical junction fig. Calyceal diverticula, also known as pyelocalyceal diverticula are congenital outpouchings from the renal calyx or pelvis into the renal cortex. 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. The upper calyx is the one that is most affected 70%.
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. On nephrographic phase contrastenhanced ct, a calyceal diverticulum will have an appearance similar to that of a simple cyst. Most of these diverticula are asymptomatic, incidentally detected, and may not require surgical intervention. 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. They are usually connected by a narrow channel to the renal pelvis, as seen in the ivp image above. We initially performed a cystoscopy and retrograde pyelogram. The stone of calyceal diverticulum was located in the upper kidney of left incomplete duplex kidneys by ct scan fig. 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. Recent findings possible methods of treatment in calyceal diverticula are generally the same as in other abnormalities of the kidney. Critical challenges of renal calculi in women medscape. May 04, 2020 calyceal diverticuli are congenital abnormalities seen on fewer than 4. The minor calyces surround the apex of the renal pyramids.
Renal cysts occur in the diverticulum of the collecting tubule. Caliceal diverticulum definition of caliceal diverticulum. The calyceal diverticula were diagnosed incidentally on routine ivps, with ct eloquently confirming the plain film findings in two cases. Calyceal diverticula are relatively uncommon tiny cystlike outpouchings communicating with the kidney collecting system and containing urine, often discovered incidentally during imaging examinations. If the diverticulum communicates with the renal pelvis, from the online textbook of urology by d. The diverticulum gradually stretches and becomes enlarged, and evacuation becomes difficult. The key points to distinguish hydronephrosis from calyceal diverticulum are the following.
Spontaneous calyceal rupture should always be considered in the differential diagnosis of a patient presenting with complex symptoms after renal colic. Challenges in the diagnosis of calyceal diverticulum. It is thought that the urinary stasis as well as other metabolic derangements allows for ions to incorporate into a stone nidus which leads to stone. 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. Sep 01, 2012 in calyceal diverticulum, tracer may accumulate in the diverticulum, rather than being excreted, and thus be detected by the gamma camera. The diverticulum is lined by transitional epithelium and surrounded by muscularis mucosae, communicating with the collecting system via a narrow isthmus or infundibulum.
The imaging appearances of calyceal diverticula complicated by. 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. Transitional cell carcinoma arising in a calyceal cyst. These diverticula are lined with transitional cell epithelium. Due to its large size, the accumulation of contrast was slow and faint.
Computed tomography urography for diagnosis of calyceal. Pyelocalyceal diverticulum is an unusual cause of renal colic. Calyceal diverticulum definition of calyceal diverticulum. Jan 01, 2017 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. This confirmed a neck of communication between the right collecting system and the large calyceal diverticulum. Request pdf calyceal diverticulum mimicking simple parapelvic cyst. Clinical manifestation of a calyceal diverticular abscess. Renal papillary and calyceal lesions may cause hematuria and can be associated with complications such as urinary tract infection. Clinical manifestation of a calyceal diverticular abscess in. A, ivp shows calculi lying outside the collecting system, because no contrast enters the upper pole diverticulum.
To examine the technique and outcomes of robotic and laparoscopic calyceal diverticulectomy in the management of symptomatic calyceal diverticula at a single center. 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. 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. Perioperative outcomes of six minimally invasive calyceal diverticulectomies four laparoscopic and two robotic between march 2011 and may 2014 were analyzed. B, ct scan confirms the presence of stones within the diverticulum, which is situated anteriorly.
Calyceal diverticulum a mimic of different pathologies on. Spontaneous calyceal rupture caused by a ureteral calculus. In 2 patients ivp at 3 months showed essentially no change in lesion size but at 6 months ivp revealed extensive shrinkage. Calyceal diverticulum is filled with contrast material in the excretory phase if. It was also evident that what had appeared to be a duplicated system on the ivp was in fact the calyx being displaced by the diverticulum. Inflammation of the walls of the diverticulum developsdiverticulitis catarrhal, ulcerative, or phlegmonous.
A complete diet guide for people with diverticulitis causes, diet and other remedial measures this book has been specifically designed and written for people who have been diagnosed with diverticulitis and seriously strive to heal and cure it with the help of a right, healthy and effective homemade diet. Kidney stone disease, also known as nephrolithiasis or urolithiasis, is when a solid piece of material kidney stone develops in the urinary tract. Renal papillary and calyceal lesions at ct urography cum laude awarded at 2015 rsna meeting ur117edmob7 satomi kawamoto, md1 peter duggan, md1 sheila sheth, md1 hiroshi miyamoto, md, phd2 zubair n. Caliceal diverticula represent a therapeutic challenge for the endourologist. These are lined by nonsecreting urothelium transitional cell epithelium. Pcnl remains effective for treating calyceal diverticular stones particularly if they are posteriorly located mid to lower pole calculi. Associated pelvicalyceal dilatation can be seen with variable degree. Technical procedure success was achieved in all cases. Hiremath 2 1 department of urology, kles kidney foundation, kle universitys jawaharlal nehru medical college, kles dr.
There is a potential pitfall for the reporter if this focal. 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 diverticuli are congenital abnormalities seen on fewer than 4. Balloonlike growths on the bladder commonly associated with a chronic outflow obstruction, such as benign prostatic hyperplasia in older males. Patients can present with both acute episodes or chronic renal papillary necrosis. Learn more about acquired calyceal diverticulum from related diseases, pathways, genes and ptms with the novus bioinformatics tool. The condition is called ureterolithiasis when a calculus is located in the ureter. Management of calyceal diverticular stones using ultramini pcnl. If the diverticulum communicates with the renal pelvis, is is called pyelogenic cyst. A calyceal diverticulum is a urinecontaining cystic cavity communicating with the collecting system via a narrow isthmus. Calyceal diverticula are rare entities that can pose a significant challenge when it comes to their management. Ureteroscopic management in selected cases, rirs management of calyceal diverticula and its related problems has been shown to be more efficacious than eswl.
Given the size of the diverticulum and its risk of rupture and infection, the family elected for surgical excision. It is congenital outpouchings of the renal calyx and communicate with the main collecting system via a narrow channel. Calyceal diverticulum is a urinecontaining cavity within the renal parenchyma, communicating with the collecting system through a narrow channel. Long term results of percutaneous treatment of caliceal. Morgan department of radiology and radiological science1 and departments of pathology and urology2 johns hopkins university, school of medicine. Usually these are incidental findings and are mostly. Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. None of these patients had stone recurrence in the residual cavities and no diverticulum smaller than 2 cm. You should also report 5235251 cystourethroscopy, with ureteroscopy andor pyeloscopy. On ivp, the ureter is dilated predominantly in its distal part. Percutaneous holmium laser fulguration of calyceal diverticula. The term calyceal diverticulum or pyelocalyceal diverticulum refers to a urinecontaining cystic cavity within the renal parenchyma. Prabhakar kore hospital and medical research centre, belgaum, karnataka, india 2 department of biotechnology and microbiology, karnatak university, dharwad, karnataka, india. Calyceal diverticulum is a relatively uncommon abnormality of the renal collecting system, with an incidence of 2.
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