DIAGNOSTIC DILEMMA: RENAL PSEUDOCYST MASQUERADING AS PYONEPHROSIS.

Abstract

Aims And Objectives Of Study: 1. To elucidate the diagnostic challenges encountered in a patient initially misdiagnosed with left pyonephrosis, subsequently revealing a rare renal pseudocyst as a consequence of pancreatitis, and to underscore the pivotal role of contrast-enhanced CT in achieving an accurate diagnosis 2. Emphasize the impact of timely intervention based on the accurate diagnosis, showcasing the improvement in patient outcomes and the importance of avoiding delays caused by misdiagnosis. Materials And Methods: 1. A retrospective analysis was conducted on a patient diagnosed with acute pancreatitis initially misdiagnosed as left pyonephrosis, subsequently revealing a perirenal pancreatic pseudocyst. Imaging studies was done including USG and CE-CT abdomen pelvis using GE voluson S8 and Siemens SOMATOM 128 slice respectively 2. Review of imaging studies, notably ultrasound scans and contrast-enhanced CT images were done using MEDSYNAPSE PACS & formed a crucial component of the study. Result: The CE-CT revealed left kidney was grossly enlarged in size with a large well-dened peripherally enhancing collection in the involving the left kidney causing mass effect over the left pelvi-calyceal system and thinned out renal parenchyma. The thinned out residual renal parenchymal tissue shows enhancement on post contrast images. However there is prompt excretion of the contrast from the left kidney. Mild perinephric fat stranding is noted with mild reactive thickening of the anterior and posterior renal fascia. A diagnosis of sequelae of necrotizing pancreatitis with walled off necrosis, peri-pancreatic and renal pseudocysts was the nal radiological diagnosis. The diagnostic odyssey of the presented case Conclusion: serves as a testament to the intricate nature of abdominal pathologies and the critical role of contrast-enhanced CT in achieving accurate diagnoses. The insights gained from this case contribute to advancing medical knowledge and advocate for a nuanced, imaging-driven approach in the evaluation of complex abdominal presentations associated with pancreatitis.