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.

PurposeChronic kidney disease (CKD) is recognized as a major worldwide health problem. For all CKD, intra-renal fibrosis is a final common pathway that can be correlated with disease severity. Tissue stiffness can be measured non-invasively using shear wave elastography. This study evaluates the use of Young’s modulus derived by SWE as a biomarker that can distinguish normal from diseased kidneys. Also, Young’s modulus was correlated with Doppler findings and estimated glomerular filtration rate (eGFR).Material and methodsThis prospective study was performed in 2 phases, in which initially 50 CKD patients and 50 controls were studied to arrive at a median Young’s modulus value in both the groups. In the later phase, a cross-sectional comparative study was conducted on 58 diabetic and 56 non-diabetic patients with SWE and renal Doppler, and the findings were correlated in various stages of CKD.ResultsUsing Young’s modulus, the renal cortex elasticity of CKD patients was shown to be considerably reduced as compared to normal kidneys. There was significant correlation between Young’s modulus, eGFR, and renal resistive index. Young’s modulus values did not show significant differences between diabetic and non-diabetic groups, revealing its inability to arrive at the aetiopathogenesis of CKD.ConclusionsCorrelation of renal tissue Young’s modulus with eGFR suggests that SWE may be used as an indicator of renal tissue injuries in CKD patients. SWE can never replace the gold standard biopsy, but it can be used for staging of CKD. Even though SWE cannot predict the aetiopathogenesis of CKD, it may be a low-cost way to provide additional diagnostic information in CKD.