MedPix® Case: 2805 - Autosomal Dominant Polycystic Kidney Disease

38.107.191.113

MedPix® Teaching File Case No: 2805

Case Summary: 2805 - || - -

Contributed by: Anonymous Resident ( National Capital Consortium ) - || -

Diagnosis

Autosomal Dominant Polycystic Kidney Disease

Dx confirmed by

* Not Provided by Author *

Demographic

Age: 46 - Gender: Male - White

History

ADPKD patient who recently underwent his second renal transplantation. The patient first underwent renal transplant 20 years ago for chronic renal failure secondary to ADPKD. After ten years, the patient rejected his transplant when he stopped taking his immunosuppresant therapy. For the past ten years, the patient has been hemodialysis-dependent.

Exam and Lab

* Not Provided by Author *

Images

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Image: 1

KUB

Image: 2

CT of ADPKD

Image: 3

CT of Transplant

Image: 4

MRI of ADPKD w/hemorrhagic cyst

Image: 5

MRI of ADPKD

Findings

1.KUB
Enlarged, irregular kidney shadows are noted bilaterally. Surgical clips in right pelvis consistent
with sight of previous transplant. Surgical staples in left flank consistent with recent renal
transplantation. Incidental finding of calcified seminal vesicles and vas deferens is noted.

2.CT of abdomen (sagital view)
(a) Lower poles of bilateral enlarged kidneys distorted by multiple macrocysts.

(b) Transplanted kidney visible in left pelvis and surgical staples noted on right abdominal wall.

3.MRI of abdomen(coronal view)

(a) TI weighted-Multiple high intensity cystic structures overwhelming both kidneys, consistent with polycystic kidney disease.

(b)T2 weighted-Bilateral enlarged kidneys with multiple low signal intensity cystic structures of various size which distort the shape of kidneys. Large area of bright signal intensity in upper pole of right kidney consistent with hemorrhagic cyst.

*****Of note is the normal-appearing kidney present in the left pelvis, consistent with recent transplantation.

*****Also of note is the absence of hepatic cysts, which frequently are present in patients with ADPKD.

Differential

Given the above radiographs, the differential diagnosis for this patient is ADPKD vs. acquired cystic disease of the kidney secondary to chronic dialysis. However, acquired disease is typically less severe and the kidneys are usually small. In this case, the diagnosis of ADPKD has been long-standing.

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