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Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound features

V Rathaus 1 O Konen 1 M Werner 1 M Shapiro Feinberg 1 M Grunebaum 2 and R Zissin 1

1Department of Diagnostic Imaging, Sapir Medical Center and 2Veteran Pediatric Radiologist, Sapir Medical Center, Kfar Saba and Sackler Medical School, Tel Aviv University, Israel



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  		Figure 1. Case 10: 15-year-old female with right abdominal pain. (a) Sagittal ultrasound of the right kidney. A simple cyst with posterior enhancement in the mid-portion. (b) Intravenous urography. Pyelocalyceal diverticulum connected to the middle calyx of the right kidney.

 


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  		Figure 2. Case 4: 47-year-old male with diffuse abdominal pain. (a) Transverse renal ultrasound of the right kidney. Cyst-like lesion with mobile hyperechogenic material with a weak posterior acoustic shadow. (b)Supine abdominal radiograph. Multiple small round calcifications (milk of calcium) in the right upper abdomen. (c) Right lateral decubitus abdominal radiograph. Linear calcifications in the right abdomen.

 


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  		Figure 3. Case 7: 24-year-old female with right lower abdominal pain. (a) Supine ultrasound of the right kidney. Hyperechoic lesion in the upper pole. (b) Left lateral decubitus ultrasound shows the same lesion at the upper pole with gravity-dependent hyperechogenic material. A posterior acoustic shadow is seen.

 


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  		Figure 4. Case 8: 41-year-old female with hypertension. (a) Transverse ultrasound image of the right kidney. A bilobed cyst-like lesion with hyperechogenic mobile material in the lateral part and posterior acoustic shadow. (b) Pre-contrast supine CT shows a bilobed hypodense mass with mobile gravity-dependent calcified material in the lateral portion. (c) Pre-contrast prone CT: change in position of the calcified material in the lateral part of the bilobate cyst.

 


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  		Figure 5. Case 9: 35-year-old male with fever of unknown origin. (a) Longitudinal ultrasound of the left kidney. Simple cyst in the mid-portion. (b) Pre-contrast CT shows a hypodense lesion in the left kidney. (c) After contrast injection no opacification is seen in the lesion. (d) 15 min after injection there is now contrast material within the diverticulum.

 




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