Presentation on theme: "Simple and Complex renal Cysts"— Presentation transcript:
1Simple and Complex renal Cysts By:Nour-Eldin A Nour-Eldin
2SIMPLE CYSTSSimple 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.
3Radiographic features , IVP: Lucent defect"Beak sign" can be seen with large cysts.Round indentations oncollecting systemCortical bulge
4Radiographic features , US: AnechoicSharply marginated,smooth wallsEnhanced through-transmission
5Radiographic features , CT: No significant enhancementafter IV contrast (<5HU)Smooth cyst wallSharp demarcationCyst wall too thin to be seen by CTHomogenous Water density (< HU)
6Be Careful:Cysts that contain calcium, septations, and irregular margins (complicated cysts)need further workupTrue renal cysts should always be differentiated from hydronephrosis, calycealdiverticulum, and peripelvic cysts.Differentiate renal cyst from hypoechoic renal artery aneurysm using color Doppler US and Angiography
10Complicated CYSTSComplicated cysts are cysts that do not meet the criteria of simple cysts and thus require further workup.
11Bosniak Classification: Category (Bosniak)US FeaturesWorkupType 1: Simple cystRound, anechoic, thin wall enhanced through transmissionNoneType 2: Mildly complicated cystThin septation, calcium in wallCT or US follow-upType 3: Indeterminate lesionMultiple septae, internal echos mural nodulesThick septaePartial nephrectomy, biopsyCT follow-up if surgery ishigh riskType 4: Clearly malignantSolid mass componentNephrectomy
12Radiographic Features of Complicated Cysts SeptationsThin septa within cysts are usually benign.Thick or irregular septa require workup.CalcificationsThin calcifications in cyst walls are usually benign.Milk of calcium: collection of small calcific granules in cyst fluid: usually benignIncreased CT density (> 15 HU) of cyst contentVast majority of these lesions are benign.High density is usually due to hemorrhage, high protein content, and/or calcium.Thick wallThese lesions usually require surgical exploration.