Left renal pseudocyst associated with alcoholic chronic pancreatitis

We report a case of a man in his forties with left renal pseudocyst formation associated with alcoholic chronic pancreatitis. Laboratory tests revealed white blood cell count 17.8×10⁹/L (reference range: 4–9×10⁹/L); C-reactive protein 20.4 mg/dL (0.0–0.3 mg/dL); serum amylase 305 U/L (65–160 U/L); lipase 81 U/L (5–35 U/L); blood urea nitrogen 21 mg/dL (8–23 mg/dL) and creatinine 0.9 mg/dL (0.6–1.3 mg/dL). Urinalysis showed no abnormality. Abdominal ultrasonography showed a left renal mass, but could not differentiate renal disease from a pancreatic pseudocyst. CT showed an atrophic pancreatic body containing pancreatic duct stones with a pseudocyst extending into the left kidney (fig 1). Endoscopic retrograde pancreatography revealed a stricture of the main pancreatic duct in the body of the pancreas. A 0.035 inch guidewire could not pass the stricture and endoscopic transpapillary drainage failed, exacerbating the patient’s abdominal pain and associated fever. Therefore, although percutaneous catheter drainage is generally not performed if the pseudocyst has some stricture downstream to the cyst, the pseudocyst was drained percutaneously under ultrasound guidance, as a temporary treatment, before performing extracorporeal shock wave lithotripsy to treat the pancreatic duct stones that might have obstructed outflow from the pancreas. As a result of these treatments, the patient showed no recurrence of the pseudocyst at 6 months (fig 2). Pancreatic pseudocysts may be found in multiple distant anatomical locations and should be included in the differential diagnosis of a renal mass lesion in patients with pancreatitis.¹

Figure 1.

CT showing a pseudocyst extending into the left kidney with pancreatic duct stones in the body of the pancreas.

Figure 2.

CT showing disappearance of the left renal pseudocyst 6 months after treatment.