Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case reportReport as inadecuate




Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report - Download this document for free, or read online. Document in PDF available to download.

Journal of Medical Case Reports

, 6:386

First Online: 13 November 2012Received: 21 June 2012Accepted: 10 October 2012DOI: 10.1186-1752-1947-6-386

Cite this article as: Marques, D.T., Bezerra, R.O.F., de Brito Siqueira, L.T. et al. J Med Case Reports 2012 6: 386. doi:10.1186-1752-1947-6-386

Abstract

IntroductionPelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography.

Case presentationWe report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum.

The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain.

A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted.

The nephrographic phase did not add any new information. The excretory phase 10-minute delay demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space.

ConclusionIn this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

KeywordsCollector system Computed tomography pelvicalyceal cyst Renal lithiasis Retroperitoneum Spontaneous rupture Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-6-386 contains supplementary material, which is available to authorized users.

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