Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 2000  |  Volume : 10  |  Issue : 1  |  Page : 47--48

Ruptured renal hydatid cyst


D Rajamagesh, A Swaminathan, VS Jeyaraman, MK Sivakkolunthu 
 Department of Radiology, Government Rajaji Hospital, Madurai, Tamil Nadu, India

Correspondence Address:
D Rajamagesh
Department of Radiology, Government Rajaji Hospital, Madurai, Tamil Nadu
India




How to cite this article:
Rajamagesh D, Swaminathan A, Jeyaraman V S, Sivakkolunthu M K. Ruptured renal hydatid cyst.Indian J Radiol Imaging 2000;10:47-48


How to cite this URL:
Rajamagesh D, Swaminathan A, Jeyaraman V S, Sivakkolunthu M K. Ruptured renal hydatid cyst. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Sep 20 ];10:47-48
Available from: http://www.ijri.org/text.asp?2000/10/1/47/30638


Full Text

Sir,

Renal hydatid is a rare entity. An incidence of 3% has been reported. [1]. A case of renal hydatid rupturing into the collecting system is reported.

A forty-two year old man presented with a dull aching pain in the right loin for two years and a history of passing vesicles in the urine on two occasions in two months. His urine microscopic examination revealed laminated membranes. A plain radiograph of the abdomen showed a well-defined, round, homogenous density mass occupying lower pole of the right kidney. No calcification was seen. Excretory urography showed a smooth round mass confining to the lower pole of the right kidney with effacement of the collecting system and splaying of the renal pelvis and upper ureter [Figure 1]. US showed a complex mass with coarse internal echoes. The collecting system was not dilated. CT after intravenous contrast showed a well-defined, smooth, thick-walled, hypodense lesion, confined to the lower pole and posterior surface of the right kidney. One section showed a streaky hyperdense region in the middle of the lesion adjacent to a lower pole calyx [Figure 2]. A diagnosis of a lower pole renal hydatid cyst communicating with a lower pole calyx was made. Partial nephrectomy was performed and the findings were confirmed.

performed and the findings were confirmed.

The usual presenting features of renal hydatid cyst are flank pain, flank mass and hematuria. Rupture into the renal pelvis may occur and presents as acute flank pain followed by voiding of debris resembling grape-skins in the urine (hydatiduria) with or without hematuria. This unusual complication is diagnosed from the presence of scolices or a laminated membrane in the urinary sediment [1],[2],[3]. EU may show a renal mass, which usually distorts the collecting system. Calcification may occur. The cyst may rupture into the collecting system and daughter cysts may be outlined in the pelvis as irregular filling defects. Occasionally the cyst is filled with contrast medium. [1]. US may reveal single or multicystic lesions of mixed echogenicity. On changing the patient's posture under real time US, there will be shifting of hydatid sand, which may give rise to the "falling snowflake pattern". CT shows a single cyst with multiple daughter cysts or a multiseptated cystic mass with or without calcifications. CT densities of the daughter cysts are significantly lower the mother cyst. [4] A post-contrast study shows dense enhancement of the pericyst. [5] If the cyst communicates with the collecting system, contrast may enter into the cyst, which may be seen as streaky hyperdense areas in the cyst. Nephrectomy or parenchymal sparing surgeries such as cystectomy or partial nephrectomy are the available treatment modalities. Percutaneous aspiration of the cyst and injection of sclerosants such as hypertonic saline (15% NaCl) or 95% absolute alcohol is the evolving interventional procedure that avoids the morbidity of open surgery and preserves the residual function of kidney.

References

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