Caliceal diverticulum in pediatric patients: the spectrum of imaging findings

Area of Science:

• Pediatric Radiology
• Uroradiology
• Pediatric Urology

Background:

• Caliceal diverticulum (CD) is an uncommon pediatric renal anomaly.
• Unlike adults, most pediatric CD cases are symptomatic, often presenting with urinary tract infections or stone formation.
• Accurate diagnosis of pediatric CD is crucial for effective management and preventing complications.

Purpose of the Study:

• To identify and characterize imaging findings of pediatric caliceal diverticulum (CD) at initial diagnosis.
• To evaluate the imaging features of pediatric CD during follow-up examinations.
• To assess the diagnostic accuracy of imaging modalities for pediatric CD.

Main Methods:

• Retrospective review of pediatric patients diagnosed with CD between 2003 and 2010.
• Analysis of presenting symptoms, associated conditions, complications, and management strategies.
• Detailed review of all radiological examinations, including delayed post-contrast CT scans.

Main Results:

• Twenty-four pediatric patients with CD were identified, with ages ranging from 2.6 to 18.5 years.
• Urinary tract infection was the most frequent presentation (n=8).
• Delayed post-contrast CT demonstrated high sensitivity (79%) for CD diagnosis, with only one false-negative case. Most CDs were solitary (n=20), and some grew over time (5/9). Stone formation occurred in 7 patients, and 15 patients required surgical intervention.

Conclusions:

• Pediatric caliceal diverticulum is often solitary, can increase in size, and may be misdiagnosed as other cystic renal lesions.
• Delayed post-contrast CT is a highly sensitive and reliable imaging technique for diagnosing pediatric CD.
• Early and accurate diagnosis of pediatric CD is essential for appropriate management and improved patient outcomes.