EUS-guided ablation of a symptomatic renal cyst in a patient with autosomal dominant polycystic kidney disease

Abstract

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A 66-year-old Caucasian woman with a history of autosomal dominant polycystic kidney disease (ADPKD) was referred to our center for EUS-guided drainage of a large pancreatic pseudocyst as diagnosed by magnetic resonance imaging (MRI) [Figure 1] and abdominal ultrasound [Figure 2]. She presented in reduced general condition and reported abdominal upper left quadrant pain and nausea for over 6 months. Laboratory results showed no signs of inflammation, and lipase levels were normal. Serum creatinine was mildly elevated, and the patient had mild microcytic hypochromic anemia.

EUS showed a cyst with 8-cm diameter between the pancreatic tail, spleen, and left kidney [Figure 3]. Due to its thin-walled appearance, completely anechoic texture, and the direct relation to the polycystic kidney as well as the missing history of pancreatitis, we diagnosed a symptomatic renal cyst rather than a pancreatic pseudocyst.

Because the patient was not considered a good candidate for surgery, we decided to perform EUS-guided ethanol ablation of the cyst. Thus, puncture with a 19G fine-needle aspiration (FNA) needle was performed, and 160 mL of clear, slightly yellowish fluid was aspirated [Figure 4]. Subsequently, 80 mL of 95% ethanol was instilled, left within the cyst for 10 minutes and subsequently re-aspirated.

No immediate complications occurred, systemic ethanol levels remained negative, and the abdominal pain and nausea fully resolved. On follow-up abdominal ultrasound 3 days later, the cyst was no longer visible [Figure 5]. Similarly, 4 weeks later, MRI confirmed a complete regression of the cyst [Figure 6].

This is one of the first reports of EUS-guided ethanol ablation of a renal cyst. Previously, percutaneous ethanol ablation of hepatic and renal cysts has been described to be safe and effective.^[1–3]^ Consistently, in our patient, this approach achieved full resolution of the cyst along with immediate symptom relief. Thus, endotherapy of symptomatic renal cysts may be considered on a case-by-case basis depending on accessibility and fitness for surgery.

Ethical Approval

Not applicable.

Informed Consent

Patient consent for publication was obtained.

Source of Funding

None.

Conflicts of Interest

None

Author Contributions

Both authors contributed to the study conception and design. Intervention was performed by Sebastian Zundler, follow-up care was co-ordinated by Jessica Arnold. The authors jointly wrote the manuscript and approved the final version.

Data Availability Statement

None