CORE CURRICULUM LECTURE 18 RENAL CYSTIC MASSES.ppt

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1. SONOGRAPHY
OF CYSTIC
RENAL
MASSES
by OKSANA H. BALTAROWICH, M.D.
Jefferson Ultrasound Research & Education Institute
We gratefully acknowledge support of this project by the Open Society Institute-New York

2. RENAL CYSTIC MASSES
•Benign
•Malignant

3. RENAL CYST

•Anechoic mass
•Smooth, thin wall
•Well-defined back wall
•Acoustic enhancement
STRICT CRITERIA

7. RENAL CYST
1.Renal carcinoma in a cyst
2.Cystic renal carcinoma
3.Cystic degeneration in
renal carcinoma
REASONS FOR STRICT CRITERIA

11. RENAL CYST COMPLICATIONS
•Hemorrhage
•Infection
•Tumor (rare)
•Recurrence post-aspiration

15. A
B
MILK OF CALCIUM

16. PERIPELVIC CYST
•Form in renal sinus
•Not true cysts
•Probably lymphatic origin
•Often bilateral
•Confused with hydronephrosis

20. PERIPELVIC CYSTS
HYDRONEPHROSIS

21. MEDIAL
LATERAL

23. DDx SIMPLE RENAL CYST
•Calyceal diverticulum
•Focal caliectasis
•Aneurysm / pseudoaneurysm
•AVM / AVF
•Papillary necrosis
•Obstructed UP duplication
•Lymphoma

26. PSEUDOANEURYSM

27. MULTICYSTIC DYSPLASTIC KIDNEY
•Unilateral abnormality
•Reniform-shaped mass
•Non-communicating cysts
•Atretic ureter
• Incidence of contralateral renal
anomaly

29. AUTOSOMAL DOMINANT PCKD
•50% have no family history
•Symptoms by age 40 - 50
–age range: fetus to 90’s
•Hypertension, hematuria,
flank pain, mass,
renal failure

31. •Cysts in other organs
–Liver 50%
–Pancreas 5-10%
–Cerebral (berry) aneurysms 20%
•Complications
–Hemorrhage
–Infection
–Calculi
AUTOSOMAL DOMINANT PCKD

32. L
K

33. •Dilation & hyperplasia of
collecting tubules
•Variable expression of disease
–age, severity
–involvement of kidney, liver
•Classification
–Perinatal-Infantile
–Neonatal-Juvenile
AUTOSOMAL RECESSIVE PCKD

36. ACQUIRED CYSTIC DISEASE
•Patients on chronic renal dialysis
•Cysts appear within 3 years
•Some with renal failure not on
dialysis
•Small, echogenic kidneys
•Complication : hemorrhage into cysts

38. MULTILOCULAR CYSTIC NEPHROMA
•Multiloculated, encapsulated mass with
echogenic septations
•Young boys, older women
•Considered benign
•Reported recurrences, distant
metastases, rapid growth

40. •Multilocular cyst of the kidney
•Cystic adenoma
•Benign cystic differentiated
nephroblastoma
•Well-differentiated polycystic Wilm’s
tumor
•Lymphangioma
MULTILOCULAR CYSTIC NEPHROMA

42. FLUID COLLECTIONS
•Subcapsular
•Perinephric
–blood (hematoma)
–pus (abscess)
–urine (urinoma)

45. KK
Pre biopsy
Post biopsy
HH
PERINEPHRIC
HEMATOMA

47. KK

49. K

50. K

51. RENAL INFECTIONS
•Acute pyelonephritis
•Renal abscess
•Pyonephrosis
•Pyelitis
•Perinephric abscess
•Xanthogranulomatous pyelonephritis

55. EMPHYSEMATOUS
PYELITIS
Coronal left kidney