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CASE REPORT
Year : 2002  |  Volume : 18  |  Issue : 2  |  Page : 184-185
 

Spontaneous rupture of a simple renal cyst


Division of Urology, Kasturba Medical College, Manipal, India

Correspondence Address:
K Sasidharan
Division of Urology, KMC, Manipal, Karnataka - 576 119
India
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Source of Support: None, Conflict of Interest: None


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Keywords: Spontaneous Rupture of Renal Cyst


How to cite this article:
Rao M, Natarajan K, Chawla A, Philipraj S J, Sasidharan K. Spontaneous rupture of a simple renal cyst. Indian J Urol 2002;18:184-5

How to cite this URL:
Rao M, Natarajan K, Chawla A, Philipraj S J, Sasidharan K. Spontaneous rupture of a simple renal cyst. Indian J Urol [serial online] 2002 [cited 2019 Dec 14];18:184-5. Available from: http://www.indianjurol.com/text.asp?2002/18/2/184/37641



   Introduction Top


A simple cyst is a discrete lesion, occurring within the kidney or on its surface, lined by a single layer of flat­tened cuboidal epithelium, filled with clear or straw-col­oured fluid and not connected to any part of the nephron. [1] Spontaneous rupture of renal cysts occurs infrequently. Accurate interpretation of the radiographic findings is im­portant in making a correct diagnosis of this unusual and frequently self-limiting process.


   Case Report Top


A 25-year-old recently married female presented with an acute continuous right loin pain of 2-days' duration. There was no other contributory urinary symptoms, trauma or comorbid illnesses. Physical examination revealed a large, ill-defined, retroperitoneal cystic mass, occupying the right lumbar, iliac and hypochondriac regions.

On further evaluation with ultrasonography, a large perinephric cystic collection was found extending from the right sub-hepatic space to the iliac fossa, with the kidney being pushed medially and with mild pelvicalyceal dilata­tion. CT scan corroborated the above findings [Figure - 1].

A right bulboureterogram disclosed a medially displaced kidney with distinctly splayed upper and middle calyces [Figure - 2]. Percutaneous drainage of right perinephric space yielded immediately 300 ml straw-coloured fluid and al­together ceased after four days. The drainage tube was removed and the patient was discharged with the intent of future review.

CT scan a month later revealed substantial reaccumula­tion of fluid in the right perinephric space. Exploratory findings were consistent with rupture of a simple renal cyst into perinephric territory. The cyst was excised to ef­fect a complete cure.


   Discussion Top


The clinical & radiological data in the case reported here is suggestive of a spontaneous rupture of a simple renal cyst. There are sporadic reports in the literature of documented cases of spontaneous rupture of simple cyst into the perinephric space. Such perinephric ruptures of simple renal cyst need cross-sectional imaging (CT scan) for proper delineation. [2]

The pathogenesis of cyst rupture operates by four differ­ent mechanisms; traumatic, infective. increase in intrapelvic pressure and alterations in fluid dynamics. [3] The mechanism of spontaneous rupture can be explained by the last three hypotheses. Inflammatory changes associated with bacterial infection may weaken the cyst wall as well as produce a rise in intracystic pressure resulting in cyst rupture. Idiopathic alterations in the dynamics of the cyst fluid could increase intracystic pressure with subsequent expansion, thereby producing a tear of cyst wall and rupture. This mechanism could have been responsible for the cyst rupture in this case as bacterial infection and distal obstruction raising intrapel­vie pressure were not demonstrable.

Once the correct diagnosis has been established, man­agement is usually conservative and may be supplemented with antibiotic coverage. Surgical, percutaneous, or angio­graphic intervention should be reserved for those with sig­nificant symptoms, uncontrolled infection, bleeding and recurrence of perinephric accumulation after a conserva­tive trial as in our case. [2]

 
   References Top

1.Glassberg KI. Renal dysplasia and cystic diseases of the kidney. In: Walsh PC, Retik AB, Vaughan ED. Wein AJ (eds.). Campbell's Urology (7th ed): Philadelphia, Saunders 1998; 2: 1789.  Back to cited text no. 1    
2.Papanicolaou N, Pfister RC, Yoder IC. Spontaneous and traumatic rupture of renal cysts : diagnosis and outcome. Radiology 1986: 160: 99-103.  Back to cited text no. 2    
3.McLaughlin AP 111, Pfister RC. Spontaneous rupture of renal cysts into the pyelocalyceal system. J Urol 1975; 113: 2-7.  Back to cited text no. 3    


    Figures

  [Figure - 1], [Figure - 2]



 

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    Introduction
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