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    Renal Cysts

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    Aliyah Tofani Pawelloi
    Simple renal cysts are common findings that arise from obstructed tubules or ducts but do not communicate with the collecting system. Most are asymptomatic but may occasionally cause hematuria, hypertension, or discomfort from mass effect. They appear as round, smoothly marginated lesions on ultrasound, CT, and intravenous pyelogram. Complicated cysts with septations, calcifications, or thick walls require further evaluation using the Bosniak classification system. Surgical intervention is often needed for Bosniak category III or IV lesions that are suspicious for renal cell carcinoma.

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    Renal Cysts

    Uploaded by

    Aliyah Tofani Pawelloi
    44 views28 pages
    Simple renal cysts are common findings that arise from obstructed tubules or ducts but do not communicate with the collecting system. Most are asymptomatic but may occasionally cause hematuria, hypertension, or discomfort from mass effect. They appear as round, smoothly marginated lesions on ultrasound, CT, and intravenous pyelogram. Complicated cysts with septations, calcifications, or thick walls require further evaluation using the Bosniak classification system. Surgical intervention is often needed for Bosniak category III or IV lesions that are suspicious for renal cell carcinoma.

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    Simple renal cysts are common findings that arise from obstructed tubules or ducts but do not communicate with the collecting system. Most are asymptomatic but may occasionally cause hematuria, hypertension, or discomfort from mass effect. They appear as round, smoothly marginated lesions on ultrasound, CT, and intravenous pyelogram. Complicated cysts with septations, calcifications, or thick walls require further evaluation using the Bosniak classification system. Surgical intervention is often needed for Bosniak category III or IV lesions that are suspicious for renal cell carcinoma.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    44 views28 pages

    Renal Cysts

    Uploaded by

    Aliyah Tofani Pawelloi
    Simple renal cysts are common findings that arise from obstructed tubules or ducts but do not communicate with the collecting system. Most are asymptomatic but may occasionally cause hematuria, hypertension, or discomfort from mass effect. They appear as round, smoothly marginated lesions on ultrasound, CT, and intravenous pyelogram. Complicated cysts with septations, calcifications, or thick walls require further evaluation using the Bosniak classification system. Surgical intervention is often needed for Bosniak category III or IV lesions that are suspicious for renal cell carcinoma.

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    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
    "Beak sign" can
    be seen with
    large cysts.

    Round indentations on
    collecting system

    Cortical bulge
    Radiographic features , US:

    Anechoic
    Sharply marginated,
    smooth walls

    Enhanced through-transmission
    Radiographic features , CT:

    No significant enhancement
    after IV contrast (<5HU)

    Smooth cyst wall

    Sharp demarcation

    Cyst wall too thin to be seen by CT

    Homogenous
    Water density (<
    10-15 HU)
    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
    Differentiate
    cysts. renal cyst from
    hypoechoic renal artery
    aneurysm using color
    Doppler US and
    Angiography
    Hydronephrosis:
    Parapelvic
    Cyst

    Calyceal
    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 Features Workup

    Type 1: Simple cyst Round, anechoic, thin None


    wall enhanced through
    transmission
    Type 2: Mildly Thin septation, CT or US follow-up
    complicated cyst calcium in wall
    Type 3: Multiple septae, Partial
    Indeterminate internal echos mural nephrectomy,
    lesion nodules biopsy

    Thick septae CT follow-up if


    surgery is
    high risk
    Type 4: Clearly Solid mass component Nephrectomy
    malignant
    Radiographic Features of Complicated
    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
    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.
    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 cont


    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
    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
    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 neoplas
    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


    Thank
    you
    Than
    k
    you

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