A)Renal cystic lesions:
Can be classified into
-Simple renal cyst.
-Polycystic kidney disease.
-Atypical renal cyst.
Simple renal cyst:
Has three main characters which are
-Sharply defined edge.
-Thin paper wall.
-Clear water content.
-And should not contains the following
*No calcification.
*No mural nodules.
*No septation.
*No enhancement.
-Could be multiple.
-I n case of contrast study, if it becomes filled with contrast, it should be considered as calyceal diverticulum and not a cyst.
Atypical renal cyst:
-Cyst containing one or more of the following
*Calcification.
*Mural nodules.
*Septations.
*Enhancement.
*Hyper dense cyst content probably due to infection, hemorrhagic or due to cholesterol content.
-Presence of calcium in the wall of a cyst shows about 25% incidence of renal cell carcinoma.
Para pelvic renal cyst:
-Can not be differentiated from renal pelvis in non contrast study.
-In contrast study, the renal pelvis becomes hyper dense while the para pelvic cyst still without contrast making differentiation easy.
Poly cystic kidney disease:
-Two types congenital and acquired.
Congenital type can be classified into
*Infantile type.
*Adult type.
Acquired type is due to long standing dialysis.
-Infantile type:
*Bilateral large kidneys discovered during prenatal ultrasound examination or shortly after birth.
*Characterized by large number of small renal cysts with illdefinition of their borders with calcified walls, in addition to other cysts seen in the liver, spleen and pancreas.
*Poor renal function.
*Usually death occurs shortly after birth.
-Adult Poly cystic kidney type:
*Is an autosomal dominant disease appears usually in fourth decade of life.
*Patient has bilateral multiple cysts causing enlarged palpable kidneys.
*The disease progresses slowly, resulting in renal failure and the needs of dialysis or transplant.
*Associated with hepatic, splenic and pancreatic cysts, in addition to berry aneurysms and diverticulitis.
*By imaging, kidneys show multiple cysts with hypo intensity in T1 and hyper intensity in T2, while some of them appears hyper dense in T1 due hemorrhage of protein contents, while others appears with fluid level due to debris.
*Wall calcification seen in CT.
*When you do a renal CT for a patient, and you discovered multiple renal cysts bilaterally, you must differentiate between multiple renal cyst disease and adult renal poly cystic disease.
Differentiation should be done by searching for
History of adult polycystic kidney disease in the family.
History of renal failure.
History of hypertension.
* Difference between infantile and adult type, look for function of kidneys, if no function, so it is infantile type.
*Presence of hepatic cysts exclude multiple renal cysts disease.
Multilocular cystic nephroma:
-Occurs in children less than 5 years and adult between 40-70 years.
-Well defined cystic lesion with thick enhanced internal septation.
-Calcification from 10-50%.
Can be classified into
-Simple renal cyst.
-Polycystic kidney disease.
-Atypical renal cyst.
Simple renal cyst:
Has three main characters which are
-Sharply defined edge.
-Thin paper wall.
-Clear water content.
-And should not contains the following
*No calcification.
*No mural nodules.
*No septation.
*No enhancement.
-Could be multiple.
-I n case of contrast study, if it becomes filled with contrast, it should be considered as calyceal diverticulum and not a cyst.
Atypical renal cyst:
-Cyst containing one or more of the following
*Calcification.
*Mural nodules.
*Septations.
*Enhancement.
*Hyper dense cyst content probably due to infection, hemorrhagic or due to cholesterol content.
-Presence of calcium in the wall of a cyst shows about 25% incidence of renal cell carcinoma.
Para pelvic renal cyst:
-Can not be differentiated from renal pelvis in non contrast study.
-In contrast study, the renal pelvis becomes hyper dense while the para pelvic cyst still without contrast making differentiation easy.
Poly cystic kidney disease:
-Two types congenital and acquired.
Congenital type can be classified into
*Infantile type.
*Adult type.
Acquired type is due to long standing dialysis.
-Infantile type:
*Bilateral large kidneys discovered during prenatal ultrasound examination or shortly after birth.
*Characterized by large number of small renal cysts with illdefinition of their borders with calcified walls, in addition to other cysts seen in the liver, spleen and pancreas.
*Poor renal function.
*Usually death occurs shortly after birth.
-Adult Poly cystic kidney type:
*Is an autosomal dominant disease appears usually in fourth decade of life.
*Patient has bilateral multiple cysts causing enlarged palpable kidneys.
*The disease progresses slowly, resulting in renal failure and the needs of dialysis or transplant.
*Associated with hepatic, splenic and pancreatic cysts, in addition to berry aneurysms and diverticulitis.
*By imaging, kidneys show multiple cysts with hypo intensity in T1 and hyper intensity in T2, while some of them appears hyper dense in T1 due hemorrhage of protein contents, while others appears with fluid level due to debris.
*Wall calcification seen in CT.
*When you do a renal CT for a patient, and you discovered multiple renal cysts bilaterally, you must differentiate between multiple renal cyst disease and adult renal poly cystic disease.
Differentiation should be done by searching for
History of adult polycystic kidney disease in the family.
History of renal failure.
History of hypertension.
* Difference between infantile and adult type, look for function of kidneys, if no function, so it is infantile type.
*Presence of hepatic cysts exclude multiple renal cysts disease.
Multilocular cystic nephroma:
-Occurs in children less than 5 years and adult between 40-70 years.
-Well defined cystic lesion with thick enhanced internal septation.
-Calcification from 10-50%.
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