Diagnosis banding

1. Renal Sinus Cyst

Merupakan istilah yang digunakan untuk menggambarkan kista yang
berdekatan dengan pelvis ginjal atau dalam hilus. Meskipun beberapa
kista peripelvic adalah kista sederhana yang timbul dari parenkim ginjal
dan mengenai pelvis ginjal, kista berasal dari sinus ginjal dan bukan dari
parenkim ginjal
(gambar) Differentiating renal sinus cysts from hydronephrosis on ultrasound.
Diagnosis of renal sinus cyst was subsequently confirmed by a computed
tomographic scan with delayed images.
(gambar) Differentiating peripelvic cysts from hydronephrosis on computed
tomography (CT). A, Axial image of the right kidney from enhanced CT has an
appearance identical to hydronephrosis (although the ureter was normal more
distally). B, Axial image of the same kidney in the excretory phase proves the
cystic structures are not in continuity with the collecting system.
(gambar) Differentiating renal sinus cysts from hydronephrosis on magnetic
resonance imaging. A, Peripelvic cysts mimic hydronephrosis on coronal T2-
weighted image. B, On excretory-phase, contrast-enhanced, T1-weighted
images, thin collecting system structures become opacified; the cysts do not.

Urinoma
A urinoma is a fluid collection formed by extravasated urine encapsulated in the perirenal
fascia.

Experimentally, the factors necessary for its formation

include:

Existing renal malfunction.

An underlying obstruction such as posterior urethral valves or pelvi-ureteric junction

obstruction.

Rupture of the collecting system.

A urinoma is supposed to be a protective pop-off mechanism in cases of increased renal

pressure. However, it can occur in the absence of urinary tract obstruction and in a low-
pressure system.

Sonographic Diagnosis:
Fetal urinoma can easily be diagnosed on prenatal ultrasound ( Figure 18-33 ). The
differential diagnosis includes hydronephrosis, cystic renal disease, duplication of the
intrarenal collecting system, cystic renal tumour, cystic lymphangioma, mesenteric cyst and
enteric duplication cyst.

FIGURE 18-33
Fetal urinoma (block arrow) in a fetus with obstructive uropathy due to posterior
urethral valves (line arrow points to massively distended fetal bladder).
(Courtesy of Dr Anne Marie Coady.)

In about 80% of the cases the renal function of the affected kidney is impaired. A change in
size of the urinoma, the use of in-utero puncture and the existence of normal or hyperechoic
renal parenchyma appear to have no influence on the prognosis, either positive or negative.
In-utero puncture only appears to be justified in cases where the urinoma has a mass effect on
adjacent major structures (especially the contralateral kidney), or in the case of probable
dystocia.

If a puncture is performed, a recurrence after aspiration is highly likely and

repeat punctures or the initial installation of a more permanent shunt could be
offered.

Pathology

Renal sinus cysts are benign. They can be subdivided into

parapelvic cysts: originate from the adjacent parenchyma and protrude into the renal
sinus

peripelvic cyst: originate within the sinus itself and have a lymphatic origin

Parapelvic cysts

These are simple renal cysts that plunge into the renal sinus from the adjacent renal
parenchyma. They are usually single or few and resemble simple renal cortical cyst in
morphology. A parapelvic cyst at times may cause compression of the pelvicalyceal system
resulting into hydronephrosis.

Peripelvic cysts

These are frequently bilateral. They appear as water attenuation cysts closely abutting the
pelvis and infundibula, rarely cause functional renal derangement by compression. When
followed up they remain unchanged in size. They may be confused with hydronephrosis on
NECT and USG, but on CECT the differentiation is obvious.

Merupakan istilah yang digunakan untuk menggambarkan kista yang

berdekatan dengan pelvis ginjal atau dalam hilus. Meskipun beberapa kista
peripelvic adalah kista sederhana yang timbul dari parenkim ginjal dan mengenai
pelvis ginjal, kista berasal dari sinus ginjal dan bukan dari parenkim ginjal. Istilah
parapelvic dan peripelvic adalah istilah yang digunakan untuk menggambarkan
lokasi kista parenkim.