Answer for BIR CoW 11 Feb 2024
Pancreatitis with renal pseudocyst and renal artery pseudoaneurysm
Findings
Features of acute pancreatitis with a large retroperitoneal pseudocyst containing haemorrhagic components . Dissection of pseudocyst into the left psoas muscle and subcapsular location of left kidney was seen causing significant compression and displacement of kidney and renal vessels. However normal renal enhancement and excretion of contrast was seen ruling out page kidney . Additionally the segmental branch of left kidney showed a tiny pseudoaneurysm on ultrasound doppler with a typical yin- yang sign , confirming the source of bleeding into the pseudocyst.
Discussion
Pancreatic pseudocysts are notorious and are known to breach through fascial planes and extend into adjacent compartments . Extension of these pseudocysts into pleural cavity is a well known phenonmenon with formation of pancreaticopleural fistula . But renal extension is a rare occurence which was seen in this case. Suspicious communication with main pancreatic duct was seen on MRCP.
Findings
Features of acute pancreatitis with a large retroperitoneal pseudocyst containing haemorrhagic components . Dissection of pseudocyst into the left psoas muscle and subcapsular location of left kidney was seen causing significant compression and displacement of kidney and renal vessels. However normal renal enhancement and excretion of contrast was seen ruling out page kidney . Additionally the segmental branch of left kidney showed a tiny pseudoaneurysm on ultrasound doppler with a typical yin- yang sign , confirming the source of bleeding into the pseudocyst.
Discussion
Pancreatic pseudocysts are notorious and are known to breach through fascial planes and extend into adjacent compartments . Extension of these pseudocysts into pleural cavity is a well known phenonmenon with formation of pancreaticopleural fistula . But renal extension is a rare occurence which was seen in this case. Suspicious communication with main pancreatic duct was seen on MRCP.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!