A new page in the literature of pancreatic pseudocyst: case report on perirenal pseudocyst presenting as page kidney

Background: Pancreatic pseudocysts are fluid collections encapsulated by a fibrous wall. They can dissect along any path of least resistance due to extravasation of enzymatic secretions into pancreatic and peripancreatic tissues. Pseudocysts extending into perirenal space are rarely encountered with paucity of data on the occurrence of secondary page kidney. We report one such rare case of pancreatic pseudocyst in the subcapsular plane of left kidney communicating with main pancreatic duct resulting in page kidney phenomenon due to compression. We discuss this case with emphasis on early identification and management of perirenal pancreatic pseudocyst, and to salvage the renal function. Case presentation: An 83-year-old chronic alcoholic male presented with complaints of abdominal pain, generalized weakness, dyspnea and loss of appetite since 2 weeks. On admission, he was diagnosed with newly detected hypertension. Patient was subjected to ultrasound and CECT abdomen and pelvis, which suggested acute pancreatitis and perirenal pseudocyst showing patent communication with main pancreatic duct resulting in decreased renal cortical opacification. Ultrasound-guided fluid aspiration of the perirenal cyst was performed, which showed significantly elevated amylase and lipase levels with inflammatory cells, hinting at pancreatic origin. Subsequently, percutaneous drainage of the cyst was done. Conclusions: Pancreatic pseudocysts at distant and atypical locations pose a diagnostic and therapeutic dilemma to the treating physician. Accurate clinical and radiological diagnosis of perirenal pseudocysts is extremely challenging. Early drainage of perirenal pancreatic pseudocyst prevents renal damage with subsequent pancreatic duct stenting avoiding its recurrence. Hence, it is of utmost importance as a radiologist to detect this uncommon complication at the earliest and guide the clinicians for efficient management.