Cystic Structures

Question 1

Congenital vs. Acquired cyst

Answer 1

Congenital: epithelial lining, developmental, multiple cysts in one organ
Acquired: no epithelial wall, age, infection (abscess), history, signs/symptoms

Question 2

Does a complex cyst need follow up?

Answer 2

Yes to rule out malignancy

Question 3

Describe a simple cyst.

Answer 3

Anechoic, strong back wall, posterior acoustic enhancement, oval/round

Question 4

Describe a complex cyst.

Answer 4

Internal echoes, septations, calcifications, thick wall

Question 5

What is the most common organ to find cysts in?

Answer 5

Kidneys

Question 6

Renal cortical cysts

Answer 6

Simple have increasing incidence with age, complex >1mm septations

Question 7

What are the 2 types of poly cystic kidney disease?

Answer 7

Autosomal dominant and autosomal recessive

Question 8

What is the most common hereditary renal disorder?

Answer 8

ADPKD

Question 9

ADPKD

Answer 9

40y/o, associated with cerebral berry aneurysms, liver, pancreas, splenic cysts

Question 10

Presentation of ADPKD

Answer 10

Palpable, pain, hematuria, hypertension, UTI’s

Question 11

Sonographic appearance of ADPKD

Answer 11

Renal enlargement (severe), multiple cysts bilaterally

Question 12

What lab tests would be abnormal with ADPKD?

Answer 12

Creatinine, BUN

Question 13

4 types of ARPKD?

Answer 13

Perinatal
Neonatal
Infantile
Juvenile

Question 14

What are all cases of ARPKD associated with?

Answer 14

Congenital hepatic fibrosis

Question 15

Sonographic appearance of ARPKD

Answer 15

Massively enlarged echogenic kidneys, loss of tissue differentiation, macroscopic cysts noted occasionally

Question 16

Parapelvic Cysts

Answer 16

Cystic dilation of lymphatic vessels, located in renal sinus, mostly asymptomatic

Question 17

Sonographic appearance of parapelvic cysts

Answer 17

Well defined, do not connect with collecting system

Question 18

What is hydronephrosis sometimes mistaken as?

Answer 18

Parapelvic cysts. - differentiate by IVP or contrast CT

Question 19

Medullary Sponge Kidneys

Answer 19

Dilated collecting tubules, 30-40 y/o, unknown etiology

Question 20

Sonographic appearance of medullary sponge kidneys

Answer 20

Bilaterally echogenic pyramids, calcifications may be present localized to pyramids

Question 21

Medullary Cystic Diseases

Answer 21

Results of progressive renal tubular atrophy, genetic

Question 22

Sonographic appearance of medullary cystic diseases

Answer 22

Small echogenic kidneys with cysts at pyramids

Question 23

What is the most common renal cystic disease in children???

Answer 23

Multicystic Dysplastic Kidneys

Question 24

How do multicystic dysplastic kidneys form?

Answer 24

Obstruction of ureter in utero

Question 25

Sonographic appearance of multicystic dysplastic kidneys

Answer 25

Small, malformed, multiple non-communicating cysts, absence of normal architecture, unilateral

Question 26

What is another name for primary congenital cysts?

Answer 26

Epidermis cyst

Question 27

What does an primary congenital cyst affect?

Answer 27

Spleen

Question 28

Primary congenital cysts

Answer 28

Affect the spleen, echogenic cystic structure, internal echoes, asymptomatic, aka: epidermoid cysts

Question 29

What is Choledochal cysts associated with?

Answer 29

Cholangiocarcinoma

Question 30

What is a choledochal cyst?

Answer 30

Fusiform dilation of CBD (tapers at ends)

Question 31

Sonographic appearance of choledochal cysts

Answer 31

Cystic structure, may contain sludge or stones, can be difficult to identify the connection to the bile duct

Question 32

Caroli’s disease

Answer 32

Rare, congenital, dilation of intrahepatic biliary tree, results in stains, stones, cholangitis and sepsis

Question 33

Sonographic appearance of caroli’s disease

Answer 33

Saccular or fusiform dilation of intraheptatic bile ducts, most often diffuse, dilated ducts contain stones and sludge

Question 34

What can increase the chances of having ARPKD and medullary sponge?

Answer 34

Having Caroli’s disease

Question 35

What does saccular mean?

Answer 35

Tube with bubble on top opposite to fusiform where there is a bulge and tapers on ends

Question 36

Cystic Fibrosis

Answer 36

Genetic, excocrine dysfunction, increased echogenicity, atrophy, small cysts but uncommonly seen on u/s

Question 37

Inclusion cysts

Answer 37

Cysts in abdominal cavity - fluid produced by ovaries gets trapped over time in a cyst that encases the ovary

Question 38

Mesenteric cysts

Answer 38

Intra-abdominal mass, variable in size, simple or complex

Question 39

What cyst arises from the wall of the GI tract?

Answer 39

Duplication cyst

Question 40

Sonographic appearance of duplication cyst

Answer 40

Filled with anechoic fluid, well defined, double layered wall, mucosal layer is echogenic, muscle is hypoechoic

Question 41

What is the most common prostatic cyst?

Answer 41

Degenerative in transitional zone

Question 42

What cyst can be associated with infertility?

Answer 42

Congenital prostatic cyst

Question 43

What are the types of congenital prostatic cysts?

Answer 43

Utricle - unilateral renal agenesis, teardrop shape Müllerian duct - no spermatozoa, tear drop shape Ejaculatory duct- fusiform, infertility Seminal vesicles - Ipsilateral renal agenesis

Question 44

What lab tests would be abnormal with liver cysts?

Answer 44

LFT, WBC

Question 45

Treatment

Answer 45

Aspiration, alcohol ablation, surgical removal, organ transplant

Question 46

What renal disease results from dilated collecting tubules?

Answer 46

Medullary sponge kidney

Question 47

Which renal cystic disease is of lymphatic origin?

Answer 47

Parapelvic cyst

Question 48

What will most likely have elevated serum creatinine levels?

Answer 48

ADPKD