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An Interesting Image of Carcinoma Breast with Renal Calyceal Diverticulum Mimicking Renal Metastasis on [18F]FDG PET/CT Scan
Address for correspondence: Dr. Tekchand Kalawat, Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. E-mail: kalawat.svims@gmail.com
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Received: ,
Accepted: ,
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
Abstract
A diverticulum is an outpouching of a hollow (or fluid-filled) structure in the body. They are most commonly seen in the urinary bladder, intestine, and pharyngeal region and are rarely seen in renal calyces. They are usually benign, asymptomatic, and are coincidentally detected. Due to their nonspecific clinical and radiological picture, sometimes they mimic malignant tumors, leading to misdiagnosis and treatment. We are presenting a case of 60-year-old female with right breast carcinoma, on whole body 18-fluorodeoxyglucose positron emission tomography-computed tomography; we observed an interesting finding in the right renal region mimicking renal metastasis.
Keywords
18-fluorodeoxyglucose positron emission tomography-computed tomography scan
calyceal diverticulum
mimicking renal metastasis
Pyelocalyceal diverticulum is an outpouching of renal calyx into the renal cortex, through narrow channel connecting with the central collecting system. They may be empty or filled with urine, stone, or calcium. It is most commonly congenital in origin with slight female preponderance.[1] Although they are usually asymptomatic, complaints of hematuria, flank pain, and urinary tract infections were also documented.[2] Diagnosis is usually made radiologically through modalities such as intravenous urograms and contrast-enhanced computed tomography (CECT), which demonstrates a lesion that connects with the pelvicalyceal system through an infundibulum and shows contrast fill-in during the excretory phase. Ultrasonography shows anechoic lesions with mobile hyperechogenic material within the diverticulum.[34]
In 18-fluorodeoxyglucose positron emission tomography examination, through physiological excretory route through the renal system, radiotracer accumulation would be seen in the diverticulum, and could be misinterpreted as renal neoplasm or metastasis leading to mismanagement.[5] However, such lesions will show washout of radiotracer on dual point imaging, and diagnosis would be confirmed by careful anatomical correlation as shown in Figure 1. Similar presentations were documented by Wang et al. and Kavanagh et al.[67] As in our case, delayed contrast filling in CECT aided in confirming the presence of benign calyceal diverticulum.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
- Pyelocalyceal diverticulum: The imaging spectrum with emphasis on the ultrasound features. Br J Radiol. 2001;74:595-601.
- [Google Scholar]
- Pyelocalyceal diverticula containing milk of calcium –CT diagnosis. Clin Radiol. 1998;53:369-71.
- [Google Scholar]
- Multi-detector row CT urography in the evaluation of hematuria. Radiographics. 2003;23:1441-55.
- [Google Scholar]
- Calyceal diverticulum found incidentally on 18F-FDG PET/CT imaging. Clin Nucl Med. 2022;11:10-97.
- [Google Scholar]
- Calyceal diverticulum mimicking a renal tumor on FDG PET imaging. Clin Nucl Med. 2006;31:301-2.
- [Google Scholar]