Presentation on theme: "By: Nour-Eldin A Nour-Eldin. SIMPLE CYSTS Simple cysts (in > 50% of population > 50 years) probably arise from obstructed tubules or ducts. They do not,"— Presentation transcript:
By: Nour-Eldin A Nour-Eldin
SIMPLE CYSTS Simple cysts (in > 50% of population > 50 years) probably arise from obstructed tubules or ducts. They do not, however, communicate with collecting system. Most commonly asymptomatic; rare: hematuria (from cyst rupture), HTN,cyst infection. Mass effect from large cysts may cause dull ache or discomfort.
Radiographic features, IVP: Lucent defect Cortical bulge Round indentations on collecting system "Beak sign" can be seen with large cysts.
Radiographic features, CT: Smooth cyst wall Sharp demarcation Homogenous Water density (< HU) No significant enhancement after IV contrast (<5HU) Cyst wall too thin to be seen by CT
Be Careful: Cysts that contain calcium, septations, and irregular margins (complicated cysts) need further workup True renal cysts should always be differentiated from hydronephrosis, calyceal diverticulum, and peripelvic cysts. Differentiate renal cyst from hypoechoic renal artery aneurysm using color Doppler US and Angiography
Calyceal Diverticulum Parapelvic Cyst
Renal Artery Aneurysm
Complicated CYSTS Complicated cysts are cysts that do not meet the criteria of simple cysts and thus require further workup.
Bosniak Classification: Category (Bosniak)US FeaturesWorkup Type 1: Simple cystRound, anechoic, thin wall enhanced through transmission None Type 2: Mildly complicated cyst Thin septation, calcium in wall CT or US follow-up Type 3: Indeterminate lesion Multiple septae, internal echos mural nodules Thick septae Partial nephrectomy, biopsy CT follow-up if surgery is high risk Type 4: Clearly malignantSolid mass componentNephrectomy
Increased CT density (> 15 HU) of cyst content Vast majority of these lesions are benign. High density is usually due to hemorrhage, high protein content, and/or calcium. Radiographic Features of Complicated Cysts Septations Thin septa within cysts are usually benign. Thick or irregular septa require workup. Calcifications Thin calcifications in cyst walls are usually benign. Milk of calcium: collection of small calcific granules in cyst fluid: usually benign Thick wall These lesions usually require surgical exploration.
Simple renal cyst, Bosniak Category I.
Bosniak Category II cyst Curvilinear calcification within a thin septum
Bosniak Category II cyst Homogeneously hyperdense mass No increase in Density after IV contrast
Bosniak Category II cyst Cyst with several internal septations and a minimally thickened wall
Bosniak Category II cyst. Cyst with uniform, mild wall thickening and short, interrupted calcifications
Bosniak Category II hyperdense cyst.
Bosniak Category II cyst
Bosniak Category II cyst. Nearly completely calcified mass with no obvious enhancing elements
Bosniak Category II. subcentimeter rim calcified renal cyst
Bosniak Category III. cystic mass with irregular wall thickening and associated heterogeneous nonenhancing elements
Bosniak Category III complex cyst. multilocular, encapsulated mass
Bosniak Category III complex cyst. Thick-walled, encapsulated, multilocular cystic mass with enhancing septa
Bosniak Category IV cystic neoplasm.
Bosniak Category IV cystic neoplasm
A 42-year-old female with back pain, hematuria, and a renal mass discovered by lumbar spine MR. hyperdense (55 HU) 3 cm mass. enhance to 88 HU after IV contrast Renal cell carcinoma