Translumbar puncture of a renal hydatid cyst

Abstract

Translumbar renal puncture is a long established and generally accepted method for the radiological investigation of renal masses, particularly those that are asymptomatic, avascular and transonic (Jeans, Penry and Roylance, 1972). Hydatid cyst, however is exceptional in that, while it may meet all these criteria, its puncture is held to carry a considerable risk of promoting local dissemination (Wright, 1972), and of causing serious anaphylaxis. In order to avoid inadvertent puncture, prior Casoni testing of patients with calcified renal masses (Jeans et al., 1972) and of patients from areas with a notable incidence of the disease (Sherwood and Stevenson, 1971) has been advocated. A case is presented in which these precautions were inadequate to prevent puncture of an unsuspected renal hydatid cyst. The examination had no untoward effects and enabled the diagnosis to be established before definitive therapy had been planned. N.C., a 42-year-old English District Nurse was admitted to hospital one week after noticing a swelling in the left hypochondrium. She felt generally well and had no other complaints. Thirteen years before she had had a full investigntion including excretion urography and retrograde pyeelography for left renal colic but no abnormality had been found. She had lived in Somerset for 20 years and had spent a week in Wales ten years earlier and a fortnight in Greece five years earlier. She kept a poodle dog and had previously owned a sheepdog.