A 48-year-old man with renal failure

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Doctor's Information

Name :  ----------------
Family :Kharrazi
Affiliation : Head of Radiology Department of Shohada Hospital
Academic Degree: ----------------
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Hussein Soleiman Tabar

Patient's Information

Gender : Male
Age : 48

Case Section

Uroradiology & Genital Male Imaging

Clinical Summary

A 48-year-old man with renal failure

Imaging Procedures and Findings

Both kidneys are enlarged and extensively replaced by numerous cysts of variable sizes.

Discussion

ADPKD is a systemic disorder; cysts appear with decreasing order of frequency in the kidneys, liver, pancreas, brain, spleen, ovaries, and testes. Cardiac valvular disorders, abdominal and inguinal hernias, and aneurysms of cerebral and coronary arteries and the aorta are also associated with ADPKD. Colonic diverticula occur in about 80% of patients with the disease. Although the disorder usually manifests in adults, it may be diagnosed during infancy and childhood. Patients with fully developed ADPKD often show dramatic CT findings. Flank pain and hematuria, the most common symptom and sign of ADPKD, may be due to cyst hemorrhage, calculi, or renal infection. Cyst hemorrhage is a common cause of pain in ADPKD and can be detected by CT in about 69% of patients. Hemorrhagic cysts have attenuation values of 40 to 100 HU on nonenhanced scans, do not enhance after intravenous administration of contrast medium, and are homogeneously hyperdense and well defined. Renal calculi occur in 20% to 36% of patients with ADPKD and commonly cause flank pain. About 57% of calculi in ADPKD are composed predominantly of uric acid and are therefore radiolucent on conventional tomography. Such calculi are best evaluated by CT. Urinary tract infections are more common in women with ADPKD and may cause cyst infection. Cyst infection is difficult to diagnose on CT; it is suggested by the finding of a cyst larger than surrounding cysts with thickening and irregularity of its wall, an increase in the attenuation value of its contents, and localized thickening of the adjacent renal fascia. The risk of renal cancer in patients with ADPKD who are not undergoing dialysis is not increased; however, patients undergoing dialysis are at greater risk for development of renal malignancy relative to the general population.

Final Diagnosis

Autosomal dominant polycystic kidney disease

References

CT and MR imaging of the whole body / [edited by] John R. Haaga ... jet al.].-5th ed