Calyceal diverticulum

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Calyceal diverticulum

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-In-Chief: Cafer Zorkun M.D., PhD.

Synonyms and Related Keywords: Pyelocalyceal diverticulum

Overview

Calyceal diverticulum is a relatively uncommon cyst-like lesion, often discovered incidentally during ultrasound examination of the kidneys. Calyceal diverticulum is a urine-containing cavity within the renal parenchyma, communicating with the collecting system through a narrow channel. [1]

Classification

  • Two types are identified:
    • One is related to a minor calyx and usually located in the upper pole
    • Other is connected with the pelvis or a major calyx in the central portion of the kidney.
  • The majority of calyceal diverticulum are small and asymptomatic, and do not require any treatment.
  • Calyceal diverticulua may rarely cause urinary tract infection, renal colic, pyuria, hematuria or hypertension.
  • Mobile calculi and milk of calcium are characteristic findings in calyceal diverticulum.

Diagnosis

Ultrasound

  • Ultrasound examination suggests the diagnosis of calyceal diverticulum and it has a variable appearance.
  • The diverticulum may appear as a cyst-like lesion, indistinguishable from a simple cyst.
  • Recognition of mobile echogenic material within such a cyst-like structure is considered characteristic of milk of calcium. A cyst-like mass with milk of calcium is presumed to be a calyceal diverticulum.

CT

  • CT has an important role in the presence of a complicated cystic mass diagnosed by ultrasound without the characteristic features of calyceal diverticulum.
  • The demonstration of the layering of contrast medium on delayed images is pathognomonic of these lesions.
  • The patency of the diverticulum is demonstrated by the gradual opacification on delayed images.

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References

  1. Rathaus, V, Konen, O, Werner, M, Shapiro Feinberg, M, Grunebaum, M, Zissin, R. Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound features. Br J Radiol 2001 74: 595-601.

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