Calyceal diverticulum
Updates to Article Attributes
Calyceal diverticula,alsoknown as pyelocalyceal diverticula are congenital outpouchings from the renal calyx or pelvis into the renal cortex. These diverticula are lined with transitional/urothelial cell epithelium.
Epidemiology
Relatively uncommon, seen in 0.21% to 0.60% of intravenous urograms (IVU).
Associations include:
- gender: females are more commonly affect than men by a ratio of 2:1
- high incidence of stone formation due to urine stagnation
Clinical presentation
The majority of the time this is ancases are asymptomatic congenital variant and discovered when patientsincidentally on imaging. Up to 50%, though, present for other complications such aswith hematuria, calculi, or repeated infectionsflank pain and/or recurring infection.
Pathology
The most common theory for the origin of calyceal diverticula is a failure of regression of the third and fourth-generation ureteric buds, as a result of obstructing stones or infection.
There are two categories of calyceal diverticula. The first and Type I is more common typeand communicates with a minor calyx. The secondType II communicates with a major calyx or the renal pelvis and tends to be symptomatic.
Radiographic features
Plain radiograph
Plain abdominal radiographers will rarely showOnly a crescent-shaped meniscus calcification of radio-opaquediverticulum containing milk of calcium withinwill be visible on a diverticulumplain radiograph. It appears as a meniscus-shaped density on an upright radiograph that changes its shape with changing position, i.e. either supine or decubitus radiographs.
Ultrasound
A calyceal diverticulum complicated by calculiCalculi or layered dependent milk of calcium appearscomplicating a calyceal diverticulum appear echogenic on ultrasound, but only the former will cast an acoustic shadow.
CT
NephrographicOn nephrographic phase contrast-enhanced CT, a calyceal diverticulum will have an appearance similar to that of a simple cyst. The diagnosis is made with certainty in the excretory phase of imaging,, when the cystic structure fills with contrast material due to communication with the collecting systeemsystem, and layering of contrast material is seen within. This helps differentiate it from a renal cyst, which does not connect with the collecting system.
A calyceal diverticulum complicated by calculi or layered dependent milk of calcium will be a high-attenuating materialhyperattenuating on an unenhanced CT.
Differential diagnosis
General imaging differential considerations include:
-<p><strong>Calyceal diverticula,</strong><strong> </strong>also<strong> </strong>known as<strong> p</strong><strong>yelocalyceal diverticula</strong> are congenital outpouchings from the renal calyx or pelvis into the renal cortex. These diverticula are lined with transitional/urothelial epithelium.</p><h4>Epidemiology</h4><p>Relatively uncommon, seen in 0.21% to 0.60% of intravenous urograms (IVU).</p><p>Associations include:</p><ul>- +<p><strong>Calyceal diverticula,</strong><strong> </strong>also<strong> </strong>known as<strong> p</strong><strong>yelocalyceal diverticula</strong> are congenital outpouchings from the renal calyx or pelvis into the renal cortex. These diverticula are lined with transitional cell epithelium.</p><h4>Epidemiology</h4><p>Relatively uncommon, seen in 0.21% to 0.60% of intravenous urograms (IVU).</p><p>Associations include</p><ul>
-</ul><h4>Clinical presentation</h4><p>The majority of the time this is an asymptomatic congenital variant and discovered when patients present for other complications such as hematuria, calculi, or repeated infections.</p><h4>Pathology</h4><p>The most common theory for the origin of calyceal diverticula is a failure of regression of the third and fourth-generation ureteric buds, as a result of obstructing stones or infection.</p><p>There are two categories of calyceal diverticula. The first and more common type communicates with a minor calyx. The second communicates with a major calyx or the renal pelvis<strong>.</strong></p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Plain abdominal radiographers will rarely show a crescent-shaped meniscus calcification of radio-opaque milk of calcium within a diverticulum.</p><h5>Ultrasound</h5><p>A calyceal diverticulum complicated by calculi or layered dependent milk of calcium appears echogenic on ultrasound</p><h5>CT</h5><p>Nephrographic phase contrast-enhanced CT will have an appearance similar to that of a simple cyst. The diagnosis is made with certainty in the excretory phase of imaging, the cystic structure fills with contrast material due to communication with the collecting systeem, and layering of contrast material is seen within. This helps differentiate it from a renal cyst, which does not connect with the collecting system.</p><p>A calyceal diverticulum complicated by calculi or layered dependent milk of calcium will be a high-attenuating material on an unenhanced CT.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include:</p><ul>- +</ul><h4>Clinical presentation</h4><p>The majority of cases are asymptomatic and discovered incidentally on imaging. Up to 50%, though, present with hematuria, calculi, flank pain and/or recurring infection.</p><h4>Pathology</h4><p>The most common theory for the origin of calyceal diverticula is a failure of regression of the third and fourth-generation ureteric buds, as a result of obstructing stones or infection.</p><p>There are two categories of calyceal diverticula. Type I is more common and communicates with a minor calyx. Type II communicates with a major calyx or the renal pelvis and tends to be symptomatic<strong>.</strong></p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Only a diverticulum containing milk of calcium will be visible on a plain radiograph. It appears as a meniscus-shaped density on an upright radiograph that changes its shape with changing position, i.e. either supine or decubitus radiographs.</p><h5>Ultrasound</h5><p>Calculi or layered dependent milk of calcium complicating a calyceal diverticulum appear echogenic on ultrasound, but only the former will cast an acoustic shadow.</p><h5>CT</h5><p>On nephrographic phase contrast-enhanced CT, a calyceal diverticulum will have an appearance similar to that of a simple cyst. The diagnosis is made with certainty in the excretory phase, when the cystic structure fills with contrast material due to communication with the collecting system, and layering of contrast material is seen within. This helps differentiate it from a renal cyst, which does not connect with the collecting system.</p><p>A calyceal diverticulum complicated by calculi or layered dependent milk of calcium will be a hyperattenuating on an unenhanced CT.</p><h4>Differential diagnosis</h4><p>General imaging differential considerations include</p><ul>
-</ul><p> </p>- +</ul>
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