K. Kiryluk, M. Gupta Kidney International

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A large obstructive parapelvic cyst: Challenging diagnosis and management K. Kiryluk, M. Gupta Kidney International Volume 71, Issue 9, (May 2007) DOI: 10.1038/sj.ki.5002124 Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 1 Computed tomography scan of the right kidney demonstrates a massive hydronephrosis and suggests a ureteropelvic junction obstruction. Note that there is no evidence of a mass within the renal pelvis. Kidney International 2007 71, DOI: (10.1038/sj.ki.5002124) Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 2 Retrograde pyelogram reveals a massive obstructive parapelvic cyst (asterisk) compressing the renal pelvis and causing severe dilation of the renal calyces (arrows). Kidney International 2007 71, DOI: (10.1038/sj.ki.5002124) Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 3 Endoscopic images from inside the cyst cavity. (a) Note the thin wall of the cyst, with retroperitoneal portions demonstrating scant vascularity. (b) Parts of the cyst abutting renal parenchyma are more whitish and exhibit more vascularity. Care must be taken during endoscopic fulguration of these portions to prevent bleeding. (c) Some parts of the cyst have minor, incomplete septations. (d) Note that retroperitoneal fat can clearly be seen through the thin cyst wall. After endoscopic ablation, often the cyst wall completely disappears and it is possible to marsupialize the cyst wall by grasping some of this fat and bringing it into the cyst cavity to prevent re-epithelialization and cyst re-formation. Kidney International 2007 71, DOI: (10.1038/sj.ki.5002124) Copyright © 2007 International Society of Nephrology Terms and Conditions

Figure 4 A follow-up computed tomography scan of the right kidney confirms partial resolution of hydronephrosis. Cortical thinning and residual scarring are also present. Kidney International 2007 71, DOI: (10.1038/sj.ki.5002124) Copyright © 2007 International Society of Nephrology Terms and Conditions