History: 42 yo female with hematuria
Solution: CALICEAL DIVERTICULUM
The caliceal diverticulum is typically a small (< 1 cm in diameter), transitional cell-lined cavity lying just peripheral to a calyx. These are seen in approximately 0.2% of the population. Although there are many theories on possible etiologies, most feel these are congenital in origin.
Most caliceal diverticula are asymptomatic and found incidentally on an imaging exam. But some report symptoms in up to one-third of patients. These symptoms can be related to obstruction with stones and infection affecting these patients. Rarely the obstruction with infection or stones will lead to overlying renal scarring. If obstruction between the diverticulum and calyx is complete, milk of calcium urine can develop. This milk of calcium urine can be substantiated by getting an upright film if this seen on a plain film of the abdomen or obtaining a CT, both showing a fluid/fluid level. Treatment is reserved for patients with symptoms.
If communication remains, the diverticulum fills passively from contrast excreted into the adjacent calyx. This abnormality must be differentiated from hydrocalix, papillary necrosis, reflux nephropathy, or even medullary sponge kidney. These diverticula tend to be single. The diverticula are reported to be mostly in the polar areas and posterior within the kidney.
The caliceal diverticulum is typically a small (< 1 cm in diameter), transitional cell-lined cavity lying just peripheral to a calyx. These are seen in approximately 0.2% of the population. Although there are many theories on possible etiologies, most feel these are congenital in origin.
Most caliceal diverticula are asymptomatic and found incidentally on an imaging exam. But some report symptoms in up to one-third of patients. These symptoms can be related to obstruction with stones and infection affecting these patients. Rarely the obstruction with infection or stones will lead to overlying renal scarring. If obstruction between the diverticulum and calyx is complete, milk of calcium urine can develop. This milk of calcium urine can be substantiated by getting an upright film if this seen on a plain film of the abdomen or obtaining a CT, both showing a fluid/fluid level. Treatment is reserved for patients with symptoms.
If communication remains, the diverticulum fills passively from contrast excreted into the adjacent calyx. This abnormality must be differentiated from hydrocalix, papillary necrosis, reflux nephropathy, or even medullary sponge kidney. These diverticula tend to be single. The diverticula are reported to be mostly in the polar areas and posterior within the kidney.
CT Images
