Presentation
Generalized abdominal pain. ? cause. History of bowel obstructions and abdominal aorta repair.
Patient Data
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- innumerable intra-abdominal thin-walled cysts identified within the kidneys and liver and to a lesser extent the pancreas. A few of the cysts are homogenously hyperdense, however the majority are fluid density
- heterogenous exophytic cyst within the mid pole of left kidney with hyperdense components on the non-contrast phase without evidence of contrast blush or pooling on the arterial or delayed phases respectively
- small volume fat stranding / free fluid within the left retroperitoneum
- evidence of prior open abdominal aortic aneurysm repair. Fusiform aneurysm of the proximal celiac trunk noted
Case Discussion
Acute left renal cyst hemorrhage / rupture on the background of autosomal dominant polycystic kidney disease (ADPKD).
Cyst rupture is a known complication of ADPKD. This case illustrates an additional history of the often more catastrophic vascular complications associated with ADPKD such as aneurysm formation (e.g. abdominal aorta and celiac axis in this case).
The patient had previously had an abdominal aortic aneurysm, which had ruptured and underwent open repair. The prior open surgery had lead to multiple adhesional small bowel obstructions. Therefore, imaging was very useful in this 'undifferentiated abdominal pain' presentation.