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Case of the Month 10/06

28 year old female presents to the ED complaining of flank pain.

Q: What’s wrong with this picture?

View answer

Numerous cysts are seen throughout the kidneys and liver.

Q: Is there a specific diagnosis you can make after viewing this CT? If so, what are the specific (radiologic) findings which need to be present to make this diagnosis?

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Yes. Polycystic kidney disease is diagnosed if two renal cysts (distributed in one or both kidneys) are present in individuals younger than 30 years of age, if two renal cysts are present in each kidney in individuals aged between 30 and 59 years, or if four renal cysts are present bilaterally in individuals older than 60 years of age.

Q: What is the prevalence of cerebral aneurysms in patients with the autosomal dominant form of this illness?

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Estimates vary widely but the reported range of cerebral aneurysm in patients with polycystic kidney disease is anywhere from 5 – 40%. Aneurysms occur much more commonly in patients with PCKD and family history of aneurysms.

Q: In which other organs may you see cysts in this disease?

View answer

Other than kidney and liver, other organs which may be involved (in decreasing order) are pancreas, spleen, brain, and ovaries/testes.