Presentation
Left loin pain, ? renal colic. No trauma.
Patient Data
Three-phase renal CT demonstrates enlarged, low attenuating kidneys. When contrast is administered, sub-capsular fluid can be identified along with a number of peripelvic cysts.
Swollen kidneys but no hydronephrosis or any calculi in the urinary tract.
On the renal parenchymal phase there is bilateral symmetrical subcapsular fluid collections with poor enhancement of renal parencyma (worse on the left). As well as symmetrical subcapsular fluid collections with poor renal parencymal contrast enhancement
On the excretory phase, there is excretion of contrast bilaterally but slower on the left with mild dilatation of renal pelvis.
The previous study showing the same subcapsular fluid collections but more normal contrast excretion. Note thickening of the upper left ureter with resultant luminal narrowing
Delayed radiograph showing relatively normal excretion on the right and hold up in region of the left PUJ. Note a double contour to the left kidney due to accumulation of contrast in the subcapsular fluid.
Case Discussion
Patient has typical features of lympangiectasia with development of chronic subcapsular not perinephric lymphatic fluid collections - producing Page kidney like appearances (i.e poor parenchymal enhancement and high renin hypertension due to relative ischemia). In this case lymphatic swelling has caused the left upper ureter to obstruct leading to a presentation of "renal colic".
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