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Case profile: intrapelvic aberrant renal papilla
CASE PROFILE:
INTRAPELVIC
ABERRANT
RENAL
PAPILLA
A thirty-nine-year-old woman was referred becauseof a five-year history of recurrent urinary tract infections without sepsis. She had experienced occasional left flank pain but had not seenblood in her urine or passedcalculi. Findings on physical examination were negative. Chemistry screening panel was normal, and there was no growth on urine culture. Urinalysis revealed l-2 red blood cells but otherwise was unremarkable. An excretory urogram, obtained three years previously, was reviewed and suggesteda lucent defect in the left renal pelvis (Fig. 1). Results of cystoscopic examination were normal except for chronic urethrotrigonitis. A left bulb retrograde pyelogram with two different views confirmed a cone-shaped lucent defect in the left renal pelvis (Fig. 2). The unchanged size and position of the defect over a three-year interval essentially eliminated the likelihood of a blood clot, uric acid calculus, or papillary tumor. The cone shape raised the
toru urogram FIGURE 1. Excretory fect in left renal pelvis (arrow).
sug!eest.s lucent Zucent desuggests
FIGURE 2. (A) Left retrograde pyelogram shows coneshaped defect. (B) Left retrograde pyelogram in right posterior oblique positio n confirms defect to be pres merit in renal pelvis.
448
UROLOGY / APRIL1987 / VOLUMEXXIX,NUMBER4
3. Computerized tomography of left kidney demonstrates renal papilla which drains directly into renal pelvis. Contrast enhancement of medullary rays of pyramid is noted.
FIGURE
raphy in the conclusive establishment correct diagnosis is apparent.
possibility of an aberrant renal papilla. Computerized axial tomography with contrast enhancement confirmed the diagnosis (Fig. 3). A rare case of an intrapelvic aberrant renal papilla is presented. In the past in a few instances diagnosis could be made only by renal exploration. The value of computerized tomog-
of the
Charles W. Bourne, M.D. Milwaukee Medical Clinic, S. C. 3003 West Good Hope Road Milwaukee, Wiscosin 53217
NOTE-Urograms of interest to OUT readers are welcome from urologists and radiologists. Contributions, including an abbreviated history and legend for the films, are to be sent to Arthur N. Tessler, M.D., feature editor.
UROLOGY
i
APRIL
1987
I
VOLUME
XXIX,
NUMBER
4
449
INTRAPELVIC
ABERRANT
RENAL
PAPILLA
A thirty-nine-year-old woman was referred becauseof a five-year history of recurrent urinary tract infections without sepsis. She had experienced occasional left flank pain but had not seenblood in her urine or passedcalculi. Findings on physical examination were negative. Chemistry screening panel was normal, and there was no growth on urine culture. Urinalysis revealed l-2 red blood cells but otherwise was unremarkable. An excretory urogram, obtained three years previously, was reviewed and suggesteda lucent defect in the left renal pelvis (Fig. 1). Results of cystoscopic examination were normal except for chronic urethrotrigonitis. A left bulb retrograde pyelogram with two different views confirmed a cone-shaped lucent defect in the left renal pelvis (Fig. 2). The unchanged size and position of the defect over a three-year interval essentially eliminated the likelihood of a blood clot, uric acid calculus, or papillary tumor. The cone shape raised the
toru urogram FIGURE 1. Excretory fect in left renal pelvis (arrow).
sug!eest.s lucent Zucent desuggests
FIGURE 2. (A) Left retrograde pyelogram shows coneshaped defect. (B) Left retrograde pyelogram in right posterior oblique positio n confirms defect to be pres merit in renal pelvis.
448
UROLOGY / APRIL1987 / VOLUMEXXIX,NUMBER4
3. Computerized tomography of left kidney demonstrates renal papilla which drains directly into renal pelvis. Contrast enhancement of medullary rays of pyramid is noted.
FIGURE
raphy in the conclusive establishment correct diagnosis is apparent.
possibility of an aberrant renal papilla. Computerized axial tomography with contrast enhancement confirmed the diagnosis (Fig. 3). A rare case of an intrapelvic aberrant renal papilla is presented. In the past in a few instances diagnosis could be made only by renal exploration. The value of computerized tomog-
of the
Charles W. Bourne, M.D. Milwaukee Medical Clinic, S. C. 3003 West Good Hope Road Milwaukee, Wiscosin 53217
NOTE-Urograms of interest to OUT readers are welcome from urologists and radiologists. Contributions, including an abbreviated history and legend for the films, are to be sent to Arthur N. Tessler, M.D., feature editor.
UROLOGY
i
APRIL
1987
I
VOLUME
XXIX,
NUMBER
4
449