Case Author(s): m quinn, md and k fischer, md , . Rating: #D2, #Q4
Diagnosis: polycystic kidney disease
Brief history:
45 yo male with increasing creatinine and decreased urine output
Images:
1 minute posterior images
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View second image(rs).
posterior post void
Full history/Diagnosis is available below
Diagnosis: polycystic kidney disease
Full history:
45 year old male with polycystic kidney disease s/p recent cyst
decortication. His urine output was decreasing, and the renogram
was ordered to evaluate renal function.
Radiopharmaceutical:
Tc99m-MAG3
Findings:
The kidneys are enlarged bilaterally. Their architecture is distorted
by numerous photopenic areas. The images also demonstrate an unusual
focus of activity in the region of the upper pole of the right kidney.
This collection appears to extend beyond the borders of the kidney.
Discussion:
The kidneys are enlarged and their architecture distorted due to the
numerous cysts that characterize adult polycystic kidney disease. The
function of these kidneys is relatively well maintained. The collection
of radiopharmaceutical in the region of the upper pole of the right
kidney was concerning for a leak into the perinephric space.
Followup:
An injection of contrast into the indwelling catheter indeed revealed
extravasation from the upper pole calyx of the right kidney. Normally,
there is no connection between the cysts of polycystic kidney disease
and the collecting system. However, in this case it was presumed that
such a connection was present, possibly formed at the time of cyst
decortication. A renal stent was placed in a retrograde fashion to
decompress the system and allow healing of the site of leak.
View followup image(gu).
anterior image from nephrostogram
ACR Codes and Keywords:
References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Organ specific)
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Case number: rs016
Copyright by Wash U MO
