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Abdomen » Kidneys/Ureters

Pyelocalyceal Diverticulum Containing Milk of Calcium

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Author(s) :

Danilo Sirigu, MD

Presentation 24-year-old female with right lower abdominal pain.

Caption: Supine transabdominal ultrasound of the right kidney

Description: Cyst-like lesion in the upper pole. The lesion contains mobile hyperechogenic material that causes a weak posterior acoustic shadow

Caption: Color Doppler examination

Description: Note Twinkling artifact arising from the content of the cyst.

Caption: Color Doppler of cyst

Description: Note "mosaic" pattern of color Doppler, indicating that the color represents an artifact, not flow within the cyst.

Differential Diagnosis simple renal cyst
hemorrhagic renal cyst
infected renal cyst
pyelocalyceal diverticulum

Final Diagnosis Pyelocalyceal Diverticulum Containing Milk of Calcium

Discussion Pyelocalyceal diverticula , also called Pyelogenic Cyst, are cystic structures within the renal parenchyma that communicate with the collecting system. Two types are identified: one is related to a minor calyx and usually located in the upper pole, while the other is connected with the pelvis or a major calyx in the central portion of the kidney. These diverticula sometimes contain milk of calcium. The majority of pyelocalyceal diverticula are small and asymptomatic, and do not require any treatment.
On Sonography, a pyelocalyceal diverticulum appears as a cystic lesion, which is difficult to distinguish from simple renal cyst. However, the presence of mobile, echogenic and dependent layering due to milk of calcium is pathognomic of a pyelocalyceal diverticulum.

Case References

Wulfsohn MA. Pyelocaliceal diverticula. J Urol 1980;123:1–8.
M Jain, SB Grover, A Kumar, NK Mohanty; Images : Pyelocalyceal diverticulum ; Genitourinary Imaging ; 14 , 3 : 279-281;2004 Indian Journal Of Radiology And Imaging. Online
V Rathaus ; O Konen ; M Werner ; M Shapiro Feinberg ; M Grunebaum; and R Zissin Pyelocalyceal diverticulum: the imaging spectrum with emphasis on the ultrasound features. British Journal of Radiology 74 (2001),595-601 © 2001 The British Institute of Radiology