Pelvicaliectasis
Pelvicaliectasis refers to the dilation of the renal pelvis and calyces—the structures within the kidney responsible for collecting urine. This term can be found in radiology reports and has many causes. This article focuses on the causes of pelvicaliectasis and the imaging tests used to diagnose it.
Understanding Pelvicaliectasis on Imaging
Pelvicaliectasis is found on imaging studies done for various reasons, such as abdominal pain or urinary tract evaluation. It is important to differentiate between physiologic (normal) dilation and pathologic dilation, which may indicate underlying problems like obstruction or infection.
What Imaging Tests Are Used?
Several imaging techniques are used in detecting and evaluating pelvicaliectasis:
1.Ultrasound
Ultrasound is often the first-line imaging test. It uses sound waves to provide a real-time view of the kidney’s structure. Pelvicaliectasis appears as an anechoic (dark) area within the kidney, representing fluid accumulation in the renal pelvis and calyces.
•Advantages: Non-invasive, no radiation, cost-effective.
•Limitations: Operator-dependent and may be less effective in obese patients.
2.CT (Computed Tomography)
CT scans are effective in identifying the cause of pelvicaliectasis. They can detect kidney stones, masses, or strictures contributing to urinary obstruction.
•Advantages: Superior anatomical detail and ability to identify causes of obstruction.
•Limitations: Exposure to radiation and potential use of contrast, which may not be suitable for patients with kidney dysfunction.
3.MRI (Magnetic Resonance Imaging)
While not routinely used, MRI can provide detailed images of the kidneys and urinary tract without radiation.
•Advantages: Excellent soft-tissue contrast, no radiation.
•Limitations: More expensive and time-consuming than other methods.
Common Causes of Pelvicaliectasis on Imaging
Identifying pelvicaliectasis is only the first step. Imaging plays an important role in identifying its underlying causes. These include:
1.Kidney Stones
Kidney stones are a leading cause of urinary obstruction and pelvicaliectasis. On CT, stones appear as dense, white structures that can obstruct urine flow. Ultrasound may also detect stones, though smaller ones are better visualized on CT.
2.Urinary Tract Obstruction
Pelvicaliectasis may result from a blockage anywhere along the urinary tract. Imaging helps locate the obstruction and determine its cause, whether it’s a stone, stricture, or tumor.
3.Pregnancy-Related Changes
Mild pelvicaliectasis is common during pregnancy. Ultrasound is the preferred imaging method for evaluating this condition in pregnant women.
4.Infections
Severe urinary tract infections, such as pyelonephritis, may present with pelvicaliectasis. Imaging can confirm the diagnosis and rule out complications like abscesses.
5.Congenital Abnormalities
Some individuals are born with structural abnormalities, such as ureteropelvic junction (UPJ) obstruction, that predispose them to pelvicaliectasis. These can be detected on ultrasound or other cross sectional studies.
How Radiologists Interpret Pelvicaliectasis
Radiologists evaluate pelvicaliectasis by considering the following factors:
•Degree of Dilation: Mild, moderate, or severe.
•Location: Whether one kidney (unilateral) or both kidneys (bilateral) are affected.
•Associated Findings: Stones, masses, or signs of infection.
In my experience, radiologists will always try to determine the cause of pelvicaliectasis on the imaging exam but this is sometimes not possible to determine. Other imaging tests and correlation with clinical data and symptoms is often needed in these cases.
Clinical Relevance of Imaging Findings
Pelvicaliectasis alone may not always indicate a problem. However, imaging findings must be correlated with clinical symptoms and additional tests, such as:
•Blood tests for kidney function (e.g., creatinine levels).
•Urinalysis to detect infection or hematuria (blood in the urine).
Management and Follow-Up Based on Imaging
The management of pelvicaliectasis depends on the underlying cause. Imaging plays a crucial role in both initial diagnosis and follow-up.
•Obstruction: May require surgical intervention, such as stent placement or lithotripsy for stones.
•Infection: Requires prompt antibiotic treatment.
•Congenital Issues: Often monitored with periodic ultrasounds to assess changes over time.
Why Early Detection Matters
Identifying pelvicaliectasis early through imaging helps prevent complications, such as kidney damage or infection.
Conclusion
Pelvicaliectasis is a common finding on imaging studies, ranging from benign to potentially serious causes. Imaging techniques, including ultrasound, CT, and MRI, are invaluable in diagnosing and managing this condition. Radiologists and clinicians rely on imaging to guide diagnosis and appropriate treatment. If you see “pelvicaliectasis” on a radiology report, rest assured that your healthcare team will use all the tools available to determine its cause and significance.
References
2.https://www.differencebetween.com/what-is-the-difference-between-pelviectasis-and-pelvicaliectasis/
3.https://my.clevelandclinic.org/health/diseases/24160-pyelectasis