CT Case 090
A 50-year-old woman presents with 3 days of frank haematuria and left loin pain. She had a fall 1 week prior to her presentation.
She has a history of polycystic kidney disease (PKCD) and is currently on haemodialysis.
His CT abdomen is shown below
Describe and interpret the CT scans
The kidneys are enlarged and almost completely replaced by innumerable cysts.
Some of the cysts have peripheral calcifications.
Several cysts are hyperdense, in keeping with intra-cystic haemorrhage.
There is also mild left perinephric stranding.
Multiple cysts are also seen in the liver.
Clinical Pearls
Polycystic kidney disease (PCKD) is a genetic disorder that may also be associated with cysts in the liver and pancreas as well as cerebral aneurysms.
Loin pain can be a common presentation for patients with PCKD.
Acute pain is often due to cyst rupture or renal calculi (incidence of 20%).
Chronic pain can occur due to cyst infection, urinary tract infection or due to cyst growth stretching the renal capsule.
70% of patients with PCKD will at some stage develop spontaneous cyst rupture and haematuria due to rupture into the collecting system. In this case, it is possible the fall contributed to the cyst rupture. The risk of rupture increases with the size of the kidneys.
Management is conservative with fluids and analgesia. For persistent bleeding with clots bladder irrigation, or stent insertion may be required.
References
- Rippey J. Ultrasound Case 033. LITFL
- Cunningham K. Abdominal Imaging Cases 006. LITFL
- Mabillard H, Srivastava S, Haslam P, Karasek M, Sayer JA. Large Retroperitoneal Haemorrhage Following Cyst Rupture in a Patient with Autosomal Dominant Polycystic Kidney Disease. Case Rep Nephrol. 2017;2017:4653267.
- Thomas L. Complications of Polycystic Kidney Disease (PKD). News Medical
TOP 100 CT SERIES
Provisional fellow in emergency radiology, Liverpool hospital, Sydney. Other areas of interest include paediatric and cardiac imaging.
Emergency Medicine Education Fellow at Liverpool Hospital NSW. MBBS (Hons) Monash University. Interests in indigenous health and medical education. When not in the emergency department, can most likely be found running up some mountain training for the next ultramarathon.
Dr Leon Lam FRANZCR MBBS BSci(Med). Clinical Radiologist and Senior Staff Specialist at Liverpool Hospital, Sydney
Sydney-based Emergency Physician (MBBS, FACEM) working at Liverpool Hospital. Passionate about education, trainees and travel. Special interests include radiology, orthopaedics and trauma. Creator of the Sydney Emergency XRay interpretation day (SEXI).
