Document Detail

CT in the evaluation of complicated autosomal dominant polycystic kidney disease.
MedLine Citation:
PMID:  10866086     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We retrospectively reviewed the CT findings in 24 cases of autosomal dominant polycystic kidney disease (ADPKD) to assess the role of CT in the diagnostic work-up of patients with complicated ADPKD. MATERIAL AND METHODS: Twenty-four patients with ADPKD underwent unenhanced and contrast-enhanced CT for flank pain, haematuria, or fever. The images were retrospectively reviewed for presence of complicated cysts, their morphological features and associated findings in the perinephric space/retroperitoneum. RESULTS: Cyst haemorrhage was present in all patients, seen as high-density cysts, which were mostly bilateral. Most of these cysts had sharply outlined contours, sharp interfaces with adjacent renal parenchyma, imperceptible walls, and homogeneous density, and did not enhance following i.v. contrast administration. However, a few haemorrhagic cysts (9 cysts in 6 patients) showed inhomogeneous density (n=7), dependent layering of high-density blood leading to fluid-fluid level (n=2), and contour irregularity (n=3). CT revealed presence of cyst infection in 6 cases; the involved cysts were larger (average size 4.2 cm) than adjacent cysts, had only a mildly increased or near water density, and showed wall thickening and enhancement. Other findings included air within the infected cyst (n=1), thickening and enhancement of peri- and paranephric fasciae (n=5), and abscesses in the posterior paranephric space and adjoining psoas muscle (n=2). In 2 other patients, although CT suggested cyst infection because of presence of wall enhancement, diagnostic needle aspiration revealed only sterile haemorrhagic fluid. In 1 case, CT revealed a soft tissue density enhancing mass in one of the cysts; this proved to be a renal cell carcinoma by fine-needle biopsy. Calculi were observed in 7 patients, and cyst wall calcification in 11 cases. CONCLUSION: A combination of unenhanced and contrast-enhanced CT allows correct diagnosis and differentiation amongst the various complications affecting patients with ADPKD. However, in a small subgroup of patients, it may not be possible to differentiate between haemorrhage and infection; such cases require diagnostic needle aspiration for diagnosis.
S Gupta; A Seith; K Sud; H S Kohli; S K Singh; V Sakhuja; S Suri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Acta radiologica (Stockholm, Sweden : 1987)     Volume:  41     ISSN:  0284-1851     ISO Abbreviation:  Acta Radiol     Publication Date:  2000 May 
Date Detail:
Created Date:  2000-07-12     Completed Date:  2000-07-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8706123     Medline TA:  Acta Radiol     Country:  DENMARK    
Other Details:
Languages:  eng     Pagination:  280-4     Citation Subset:  IM    
Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
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MeSH Terms
Abdominal Pain / radiography
Abscess / radiography
Aged, 80 and over
Biopsy, Needle
Calcinosis / radiography
Carcinoma, Renal Cell / pathology,  radiography
Contrast Media / administration & dosage
Fascia / radiography
Fever / radiography
Hematuria / radiography
Hemorrhage / radiography
Infection / radiography
Injections, Intravenous
Kidney / radiography
Kidney Calculi / radiography
Kidney Neoplasms / pathology,  radiography
Middle Aged
Polycystic Kidney, Autosomal Dominant / radiography*
Psoas Abscess / radiography
Radiographic Image Enhancement
Retrospective Studies
Tomography, X-Ray Computed*
Reg. No./Substance:
0/Contrast Media

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