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Uroradiology > renal cystic lesions > Flashcards

renal cystic lesions Flashcards

1
Q

What is the composition of a simple cortical cyst? Where do they arise from?

A

Fibrous tissue lined by flattened cuboidal epithelium containing clear serous fluid

Distal convoluted tubule or collecting duct

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2
Q

When measuring cortical cyst wall thickness, what portion of the wall is measured?

A

The exophytic portion, as the parenchymal portion can be confused with the renal parenchyma

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3
Q

On radionucleotide scans, what feature distinguishes the photopenic cystic lesion from frank hydronephrosis

A

With a cystic mass lesion, the agent will still fill into the ureter

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4
Q

What are the most common clinical manifestations of cyst rupture

A

hematuria and flank pain

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5
Q

What is segmental cystic disease of the kidney?

A

Replacement of all/most of one kidney by multiple cysts

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6
Q

What features make a septation benign of malignant?

A

Benign - thin, smooth, no nodularity

Malignant - thick, nodular solid mass component

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7
Q

What findings make a cyst complicated?

A

Septations (thicker/nodular are worse)
Thick wall
Hyperdensity
Enhancement

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8
Q

What is the main difference between hyperdense cyst and renal carcinoma?

A

Both may look like well defined homogenous hyperdense lesions, but cysts will not enhance

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9
Q

What is pseudoenhancement? What is the problem solving technique?

A

spurious increase in enhancement after contrast administration caused by the reconstruction algorithm used by modern scanners to adjust for beam hardening effects.

Most pronounced during the early phases of enhancement

Can be reevaluated with alternate imaging modality such as US

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10
Q

What is a Bosniak class I lesion

A

simple cyst with no atypical features

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11
Q

What is a Bosniak class II lesion

A

some atypical features though likely benign

thin nonenhancing septa or rimlike calcification

nonehancing hyperdense lesions (hemorrhagic, proteinacious)

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12
Q

What is a bosniak class IIF lesion

A

minimally complex with suspicious features

increased septa with minimally thickened septa +/- calcifications

hyperdense cysts >3cm that is >75% intrarenal

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13
Q

What is a bosniak class III lesion

A

Complex

complex septations

multiloculated cysts, thickened walls, dense calcifications, minimal enhancement

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14
Q

What is a bosniak class IV lesion

A

likely malignant

solid mass with cystic or necrotic component

enhancing solid component or thick irregular walls

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15
Q

What is a milk of calcium cyst? Where are they seen?

A

Collection of small calcific granules in the cystic fluid (CaCO3) in suspension and layered in the dependent portion.

Seen in the calyceal diverticulum

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16
Q

What are the extrarenal associations with medullary cystic disease in the juvenile population “juvenile nephronophthisis”

A

retinal degeneration
hepatic fibrosis
skeletal abnormalities

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17
Q

Where are the cysts in medullary cystic disease

A

medulla, up to 2cm in diameter

cortex is thinned but does not contain cysts

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18
Q

How are the uremic medullary cystic diseases classified?

A

By age

adult - auto dom MCD

kids - juvenile nephronophthisis

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19
Q

What are the clinical signs associated with auto dom medullary cystic disease

A

severe anemia with progressive renal failure

salt wasting nephropathy not correct with mineralocorticoids

fixed low specific gravity on UA

HTN late

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20
Q

What is the clinical course of juvenile nephronophthisis

A

Onset at 3-5 years

anemia and progressive renal failure, more indolent than the adult version

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21
Q

What are the imaging features in medullary cystic disease

A

US - loss of corticomedullary differentiation, hypoechoic parenchyma compared to liver/spleen

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22
Q

What is the worrisome association with ARPKD

A

hepatic fibrosis progressing to portal HTN and esophageal varices

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23
Q

Where is the chromosome for ARPKD

A

6

24
Q

What is the relationship between hepatic and renal manifestations of ARPKD

A

inverse; if renal failure, hepatic fibrosis is mild and vice versa

Renal manifestations are seen in the younger patients

Hepatic manifestations are more prominent in the older children

25
Q

What are the radiologic manifestations of neonatal ARPKD

A

massive enlargement of the kidneys with maintanence of the reniform shape. Poor renal function is noted clinically

Blotchy opacification on the nephrogram phase with linear striations due to contrast stasis in dilated renal tubules

Small cysts in cortex and medulla cause increased echogenicity on US

Prominent renal pelvis and calyces may results in sonolucent central zone

26
Q

What are the radiologic manifestations of juvenile ARPKD

A

Congenital hepatic fibrosis

mildly enlarged but variably sized cysts predominantly medullary in location

increased echogenicity with loss of normal corticomedullary junction

27
Q

Where are the chromosomes for the two types of ADPKD? Which is more common?

A

type I - more common, 16

type II - less common, 4

28
Q

What is the relation between age of onset and severity in ADPKD? What is the expressivity vs penetrance?

What are the associated nonrenal findings?

A

Later age (>50) better prognosis

100% penetrance
variable expressivity

Saccular berry aneurysms in circle of willis!!!!!
hepatic cysts
mitral valve prolapse
colonic diverticulosis

29
Q

What is the feared complication with ADPKD?

A

RCC

30
Q

What are the CT findings in ADPKD?

A

innumerable irregularly shaped cysts varying from simple to hemorrhagic to infected

hepatic cysts

31
Q

Where is the pathology in glomerulocystic disease?

A

dilation of bowmans space leads to multiple minute cysts, smaller than those in ADPKD

32
Q

What is multicystic dysplastic kidney? What is the pathophysiology? who get unilateral/bilateral?

A

Collection of irregularly sized cysts and fibrous tissue without functioning renal parenchyma.

Atresia of the ipsilateral renal vessels with small/absent renal collecting system

Occlusion of the fetal ureters at 8-10 weeks gestation

Uni - male
Bilateral - female

33
Q

What is the most common abdominal mass in a neonate? second most?

A

Hydronephrosis

Multicystic dysplastic kidney

34
Q

What are the renal associations with multicystic dysplastic kidney?

A

UPJ obstruction
hypoplasia of opposite kidney
horseshoe kidney

35
Q

What are the 3 main findings in multicystic dysplastic kidney?

A

Irregular mass of dysplastic cystic tissue
No renal artery
Absent collecting system and atretic/absent ureter

36
Q

What are the CXR findings of multicystic dysplastic kidney? CT? US?

A

soft tissue flank mass with cystic wall calcification

compensatory hypertrophy of the contralateral kidney

multiple cysts with thick septa and mural calcifications (CT)

37
Q

who gets segmental multicystic renal dysplasia

A

partial obstruction in utero with an ectopic ureterocele

38
Q

What is the difference between classic and hydronephrotic multicystic dysplastic kidney? Why is it important

A

Hydronephrotic subtype has communication between the cysts and pelvis

Hydronephrosis can have surgery to preserve renal function

39
Q

What is multilocular cystic nephroma

A

well circumscribed lesion containing many cysts of variable sizes

surrounded by a thick fibrous capsule that compresses adjacent renal parenchyma and often projects into the renal pelvis

40
Q

What is the age difference in multiloculated cystic nephroma?

A

Males 40yo

41
Q

What are the US and CT findings in multilocular cystic nephroma

A

US - large lesion with multiple locules separated by echogenic stroma

CT - 10cm lesion sharply delineated from adjacent renal parenchyma. Lesion doesnt enhance, but septations will

HERNIATION OF MASS INTO PELVIS

42
Q

What are the renal findings in tuberous sclerosis?

A

Zits, fits, and nitwits

80% have AML

increased incidence of cysts, usually

43
Q

What are the findings in VHL? What are the three types?

A 
Cerebellar and retinal hemangioblastoma
RCC
Renal cysts
Pancreatic islet cell tumors and cysts
Pheochromocytoma

Type I - retinal/CNS hemangioblastoma, renal cyst/RCC, pancreatic cystic disease

Type IIA - retinal/CNS hemangioblastoma, pheochromocytoma, pancreatic islet cells tumors, NO RENAL DISEASE

Type IIB - Type I + pheochromocytoma

44
Q

What is the pathophysiology behind cyst development in dialysis?

A

Incomplete removal of toxins induces fusiform dilations of proximal renal tubules

45
Q

What is the risk of malignancy in dialysis patients?

A

3-6x general population

46
Q

After renal transplant, what happens to the cysts and cancers in dialysis patients?

A

Cysts tend to regress

Still slight increased risk of cancer

47
Q

What is acquired renal cystic disease? What are the renal findings

A

Seen after longterm dialysis

multiple cysts in small/normal kidneys
increased risk of renal cancer
dystrophic calcification

48
Q

What is renal lymphangiomatosis>?

A

presence of multiple cysts in both the renal sinus and renal parenchyma

49
Q

What are the renal findings in orofaciodigital syndrome?

A

multiple renal cysts with development of renal insufficiency

50
Q

What are the features of a hydatid cyst that separate it from a simple cyst?

A

curvilinear calcification of the wall, septations, scolex/daughter component

51
Q

What is a pyelogenic cyst?

A

cyst that communicates with the collecting system through and narrow isthmus

The connection is at the fornix but can be at any portion of the calyx

52
Q

What is the difference in contrast filling between a calyceal diverticulum and hydronephrosis?

A

The normal calyces will fill in before the diverticulum, whereas hydronephrosis will fill in the large cystic portion first

53
Q

What is the difference between parapelvic and peripelvic cysts

A

Para - renal sinus cyst

Peri - multiple lymphatic dilations

54
Q

How can you tell the difference between renal pelvic lipomatosis and parapelvic cysts?

A

Lipomatosis will have fat attenuation/echogenicity

55
Q

What is a perinephric cyst?

A

Not a true cyst, thought to be due to collection of urine after trauma

Located under the renal capsule

Uroradiology (11 decks)

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