Spontaneous combined rupture of a pelvicalyceal cyst into the collector system and retroperitoneal space during the acquisition of computed tomography scan images: a case report

Abstract Introduction Pelvicalyceal cysts are common findings in autopsies and can manifest with a variety of patterns. These cystic lesions are usually a benign entity with no clinical significance unless they enlarge enough to cause compression of the adjacent collecting system and consequently obstructive uropathy. Few cases of the spontaneous rupture of pelvicalyceal renal cysts have been published and to the best of our knowledge there is no report of a combined rupture to collector system and retroperitoneal space documented during a multiphase computed tomography. Case presentation We report a case of a ‘real-time’ spontaneous rupture of a pelvicalyceal cyst into the collecting system with fistulization into the retroperitoneum. The patient was a 78-year-old Caucasian man with a previous history of renal stones and a large pelvicalyceal renal cyst who was admitted to our Emergency department with acute right flank pain. A multiphase computed tomography was performed and the pre-contrast images demonstrated a right pelvicalyceal renal cyst measuring 12.0 × 6.1cm in the lower pole causing moderate dilation of the upper right renal collection system. In addition, a partially obstructive stone on the left distal ureter with mild left hydronephrosis was noted. The nephrographic phase did not add any new information. The excretory phase (10-minute delay) demonstrated a spontaneous rupture of the cyst into the pelvicalyceal system with posterior fistulization into the retroperitoneal space. Conclusion In this case study we present time-related changes of a rare pelvicalyceal cyst complication, which to the best of our knowledge has fortunately not been previously documented. Analysis of the sequential images and comparison with an earlier scan allowed us to better understand the physiopathological process of the rupture, the clinical presentation and to elaborate hypotheses for its etiopathogenesis.

Conceptual problem for noncommutative inflation and the new approach for nonrelativistic inflationary equation of state

In a previous paper, we connected the phenomenological noncommutative inflation of Alexander, Brandenberger and Magueijo [ Phys. Rev. D 67 081301 (2003)] and Koh and Brandenberger [ J. Cosmol. Astropart Phys. 2007 21 ()] with the formal representation theory of groups and algebras and analyzed minimal conditions that the deformed dispersion relation should satisfy in order to lead to a successful inflation. In that paper, we showed that elementary tools of algebra allow a group-like procedure in which even Hopf algebras (roughly the symmetries of noncommutative spaces) could lead to the equation of state of inflationary radiation. Nevertheless, in this paper, we show that there exists a conceptual problem with the kind of representation that leads to the fundamental equations of the model. The problem comes from an incompatibility between one of the minimal conditions for successful inflation (the momentum of individual photons being bounded from above) and the Fock-space structure of the representation which leads to the fundamental inflationary equations of state. We show that the Fock structure, although mathematically allowed, would lead to problems with the overall consistency of physics, like leading to a problematic scattering theory, for example. We suggest replacing the Fock space by one of two possible structures that we propose. One of them relates to the general theory of Hopf algebras (here explained at an elementary level) while the other is based on a representation theorem of von Neumann algebras (a generalization of the Clebsch-Gordan coefficients), a proposal already suggested by us to take into account interactions in the inflationary equation of state.