ABSTRACT
La hidatidosis es una parasitosis producida por larvas de Echinococcus, las cuales forman quistes frecuentemente localizados en hígado y pulmón; la localización renal sólo ha sido reportada en el 4% de formas viscerales. Presentamos el caso de un varón de 19 años procedente de la sierra de Lima, el cual acude a nuestro hospital con dolor en flanco izquierdo y hematuria, se le realizó una tomografía sugerente de quiste simple complicado. Se le realizó nefrectomía y se envió la pieza al servicio de anatomía patológica, en el cual observó formación quística en cuyo interior se encontraron múltiples membranas blanquecinas plegadas. En el examen microscópico se observaron membranas anhistas, consistente con quiste hidatídico renal.
Hydatidosis is a parasitosis produced by Echinococcus larvae, which form cysts frequently located in the liver and lung; Renal location has only been reported in 4% of visceral forms. We present the case of a 19-year-old man from Lima, who came to our hospital with pain in the left flank and hematuria, a tomography was performed suggestive of complicated simple cyst. A nephrectomy is performed and the piece is sent to the Pathology Department, in which they observe cystic formation inside which multiple folded whitish membranes are observed: in the microscopic examination anhistic membranes are observed, consistent with a renal hydatid cyst.
ABSTRACT
Summary Objective: To investigate the positive association between the presence of simple renal cysts (SRCs) and abdominal aortic aneurysm (AAA). Method: In a retrospective case-control study including subjects aged > 50 years, we evaluated the incidence of SRCs on computed tomography (CT) scan. We compared 91 consecutive patients with AAA referred from the Division of Vascular Surgery and 396 patients without AAA, randomly selected after being matched by age and gender from 3,186 consecutive patients who underwent abdominal CT. SRC was defined as a round or oval low-attenuation lesion with a thin wall and size > 4 mm on CT without obvious evidence of radiographic enhancement or septations. Patients were considered as having AAA if the size of aorta was greater than 3.0 cm. Results: Patients with AAA and without AAA were similar in terms of age (67.9± 8.41 vs. 68.5±9.13 years) (p=0.889) and gender (71.4 vs. 71.2% of male subjects, respectively) (p=0.999). There was no difference in the prevalence of SRC between case and controls. Among individuals with AAA, 38 (41.8%; [95CI 32.5-52.6]) had renal cysts compared to 148 (37.4%; [95CI 32.7-42.2]) in the control group (p=0.473), with a prevalence ratio (PR) of 1.16 (95CI 0.80-1.68). Conclusion: We found no significant differences in the prevalence of SRCs among patients with AAA and controls. Our findings suggest that the presence of SRCs is not a risk factor or a marker for AAA.
Resumo Objetivo: Avaliar uma possível associação entre presença de cistos renais simples (CRS) e aneurisma aórtico abdominal (AAA). Método: Em um estudo de caso versus controle com sujeitos com idade > 50 anos, avaliamos a prevalência de CRS detectados por tomografia computadorizada (TC). Comparamos os achados de 91 pacientes consecutivos com AAA oriundos da Divisão de Cirurgia Vascular com 396 pacientes sem AAA, randomicamente selecionados e ajustados por idade e gênero dentre 3.186 pacientes consecutivos que se submeteram a TC abdominal. Cisto simples foi definido como lesão hipodensa oval ou arredondada com paredes finas, maiores do que 4 mm em TC sem realce contrastual ou septação. Pacientes foram considerados com AAA quando o diâmetro da aorta era maior que 3,0 cm. Resultados: Pacientes com AAA e sem AAA eram semelhantes quanto a idade (67,9±8,41 vs. 68,5±9,13 anos) (p=0,889) e gênero (71,4 vs. 71,2% dos indivíduos masculinos, respectivamente) (p=0,999). Não havia diferença de prevalência de CRS entre casos e controles. Dentre indivíduos com AAA, 38 (41,8%; [IC95% 32,5-52,6]) tinham cistos renais, comparados com 148 (37,4%; [IC95% 32,7-42,2]) no grupo controle (p=0,473), com uma razão de prevalência (RP) de 1,16 (IC95% 0,80-1,68). Conclusão: Não observamos diferenças significativas na prevalência de CRS entre pacientes com AAA e controles. Nossos resultados sugerem que presença de CRS não é fator de risco ou preditor para AAA.
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aortic Aneurysm, Abdominal/complications , Kidney Diseases, Cystic/complications , Tomography, X-Ray Computed , Case-Control Studies , Retrospective Studies , Aortic Aneurysm, Abdominal/diagnostic imaging , Kidney Diseases, Cystic/diagnostic imaging , Middle AgedABSTRACT
PURPOSE: To carry out long-term follow-up of patients diagnosed with asymptomatic simple renal cysts (SRCs). MATERIALS AND METHODS: One hundred fifty-eight adult patients in whom SRCs were incidentally diagnosed by abdominal ultrasonography or abdominopelvic computed tomography between August 1994 and June 2004 were followed up for over 10 years. The retrospective analysis investigated sequential changes in the size, shape, and Bosniak classification of the renal cyst and analyzed risk factors for increased size and growth rate of the cysts. RESULTS: The median follow-up period was 13.9 years (range, 10.0-19.8 years). Median patient age was 54.1 years (range, 22-86 years). Mean maximal cyst size was 33 mm (range, 2-90 mm). Among all patients, 120 (76%) showed a mean increase in maximum renal cyst diameter of 1.4 mm (6.4%) per year. Age at initial diagnosis was a risk factor for increased renal cyst maximum diameter. The probability of an increase in maximum diameter of an SRC was 7.1 times greater in patients aged 50 years or older at diagnosis than in those aged less than 50 years. However, among patients with an increased maximum diameter, the mean growth rate was lower in patients aged > or =50 years than in those aged <50 years. CONCLUSIONS: About three-quarters of adult patients with accidentally diagnosed SRCs presented with an increased maximum diameter. The only risk factor for an increase in maximum diameter was age. In patients with an increase in the maximum diameter, the growth rate of the maximum diameter was 6.4% per year during 10 years and decreased with age.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Age Factors , Cysts/diagnostic imaging , Follow-Up Studies , Kidney Diseases, Cystic/pathology , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Spontaneous renal rupture with hemoperitoneum in patients receiving continuous ambulatory peritoneal dialysis (CAPD) is very rare. Hemoperitoneum in peritoneal dialysis patients is often attributed to mechanical, gynecological or intraperitoneal abdominal pathology. Few cases have been described with retroperitoneal bleeding in CAPD patients. Hence we report one case of spontaneous renal rupture with retroperitoneal hemorrhage and haemoperitoneum in a CAPD patient with acquired cystic kidney disease.