Georgian Telemedicine Union (Association)

Patient: Female

Age: 55

Computer Tomography analysis. Computer tomography of abdomen area was performed with intravenous contrast intensification. Contrast substance was given to patient in amount 250 ml per os.

Liver is not enlarged, doesn’t extend rib arc, contours are obvious, structure – homogenous. Focal damage is not observed in liver parenchyma, density – normal. Bile ducts are not enlarged too.

Pear-shaped gallbladder is characterized by normal size and partially thickening walls. Content of cavity is homogenous.

Spleen is characterized by normal predisposition, size, form and structure. Contours are obvious.

Pancreas size is normal, structure homogenous, contours obvious. Wirsung’s duct is not dilated, para pancreatic adipose tissue without visible pathology.

Adrenal glands - normal.

Kidney. In upper segment of right kidney parenchyma homogenous formation with obvious contours – cyst, is revealed. Urethra and pelvis are not dilated.

Left kidney is replaced caudally. In area of upper pole and under kidney capsule (projection upper pole - lower pole) 8x5x10 cm size formation of heterogeneous density (45-56HU) is revealed. As a result of intravenous contrasting density was not changed. In its thickness inclusions of increased density (68-73 HU) can be observed.

Contrasting of left kidney parenchyma is uniform, size is normal. In middle segment 3 cm size cyst was observed, it pressures pelvis. At the border of middle and lower segments laterally and frontally in parenchyma 2 cm size second formation – cyst, is observed. Contour of mentioned formation merged with formation in sub capsular area.

Urethra and pelvis of left kidney are not dilated.

Garrett fascia is obviously thickening at left; para-renal adipose tissue is partially thickening too.

Portal vein, abdomen aorta – without pathology.

Retroperitoneal lymph nodes are not enlarged.

Liquid is not observed in abdomen cavity.

Nodular changes are not observed in studied bone structures.

Conclusion: Cyst of both kidneys. It is plausible, that formation under capsule of left kidney has liquid genesis. Its high density doesn’t exclude presence of blood. Infection is suspected too. Same CT appearance is characteristic for peri-renal lymphoma too.

Peripheral blood analysis lightly revealed hypochromal anemia and anizocytosis were revealed. Erythrocyte Sedimentation Rate – 48.

Ultrasound investigation of left kidney revealed 130x86 mm size formation. Surrounded liquid formation around kidney parenchyma (sub-capsular localization is suspected) is observed. It is plausible, that this is sub-capsular hematoma, which pressures parenchyma. Thickness of parenchyma is 12-14 mm. Upper pelvis is dilated (up to 21 mm). Concrements are not revealed. Breach of capsule integrity was revealed in upper one third.

Comments: Please, write Your opinion and the suggestions about the further treatment strategy of this case to Eka Kldiashvili, Ph.D. kldiashvili@georgia.telepathology.org, Georgian Telemedicine Union (Association), Tbilisi, Georgia.

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