Figure 922

Autosomal-dominant polycystic kidney disease (ADPKD): specific causes of acute abdominal pain. The most frequent cause of acute abdominal pain related to ADPKD is intracyst bleeding. Depending on the amount of bleeding, it may cause mild, transient fever. It may or may not cause gross hematuria. Cyst hemorrhage is responsible for most high-density cysts and cyst calcifications demonstrated by CT. Spontaneous resolution is the rule. Excretory urography or enhanced CT is needed mostly to locate obstructive, faintly opaque stones. Stones may be treated by percutaneous or extracorporal lithotripsy.

Renal infection may involve the upper collecting system, renal parenchyma, or cyst. Parenchymal infection is evidenced by positive urine culture and prompt response to antibiotherapy; cyst infection by the development of a new area of renal tenderness, quite often a negative urine culture (but a positive blood culture), and a slower response to antibiotherapy. CT demonstrates the heterogeneous contents and irregularly thickened walls of infected cysts. Cyst infection warrants prolonged anti-biotherapy [3]. An example of severe, intractable cyst infection is shown in Figure 9-21.

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