15 Solitary or Multiple Filling Defects in the Pelvocalyceal System

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GU 15-1 Cystine stones. (A) Plain film shows multiple radiopaque calculi. (B) Excretory urogram demonstrates the stones as lucent filling defects in the opacified renal pelvis.

Fig GU 15-2 Xanthinuria. A large lucent stone (arrows) almost fills the right pelvocalyceal system.

• Fig GU 15-3 Blood clot. Large filling defect with a smooth contour (arrows). A CT scan showed the attenuation value of the blood clot to be 62 H, a density higher than that of transitional cell carcinoma but lower than that of a nonopaque stone.13

• Fig GU 15-4 Transitional cell carcinoma of the renal pelvis in two patients. (A) A small filling defect (arrow) in the renal pelvis simulates a blood clot, stone, fungus ball, or sloughed papilla. (B) A huge mass fills virtually all the renal pelvis.

• Fig GU 15-5 Transitional cell carcinoma of the renal pelvis. A small filling defect occupies an interpolar calyx (arrows). Although the defect might at first be mistaken for a large but otherwise normal papilla, the many small contrast stipples and the suggestively irregular border make its neoplastic nature evident.14

• Fig GU 15-6 Sloughed papillae in papillary necrosis. A ring of contrast material (long arrows) surrounds a triangular lucent filling defect, which represents an almost complete papilla that has been separated from the rest of the renal parenchyma. The short arrows point to less severe extension of contrast material from the calyces into the papillae.7

• Fig GU 15-7 Fungus ball in renal candidiasis. Retrograde pyelogram demonstrates a large filling defect (arrows) in the left renal pelvis.15

• Fig GU 15-8 Acute pyelonephritis. Linear striations (arrow) in the right renal pelvis.