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AB&SS2 > C1: Cystic Diseases > Flashcards

C1: Cystic Diseases Flashcards

1
Q

what is a cyst

A

walled off collection of fluid

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2
Q

what are the 2 types of cysts

A

true

acquired

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3
Q

describe the characteristics of a true cyst

A

has an epithelial wall.

congenital…. so either hereditary or developmental

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4
Q

describe the characteristics of an acquired cyst

A

no epithelial wall.

acquired through trauma or infection (can be parasitic or inflammatory)

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5
Q

can you tell if a cyst has an epithelial wall on US

A

no

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6
Q

describe some US features that can help differentiate a true cyst from an acquired one

A

often you’ll see multiple cysts in one organ, or multiple organs w/ cysts

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7
Q

describe 3 items that can help you differentiate an acquired cyst from a true one

A

history
signs
symptoms
(could also use lab values)

often you’ll see only one cyst

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8
Q

4 US criteria for simple cyst

A

anechoic
strong back wall
Posterior enhancement
round or oval (produces refractive edge shadowing)

MUST meet all 4 criteria

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9
Q

why is it important to differentiate simple from acquired cysts

A

helps direct the course of treatment… simple doesnt need a follow up, complex needs further testing to R/O malignancy

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10
Q

describe the possible appearance of complex cysts

A

do not meet the criteria for a simple cyst

...internal echos due to hemorrhage or infection
septations
calcifications
thick walls or mural nodularity
debris
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11
Q

does age increase the occurrence of cysts

A

yes

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12
Q

specifically, what organs are most likely to develop cysts as we age

A

liver and kidneys

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13
Q

multiple cysts can indicate what type of abnormality

A

genetic

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14
Q

the possible symptoms of a cyst depend on what factors

A

size
number
location

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15
Q

list some symptoms of cysts

A 
pain
pressue
increased lab values
jaundice
fever

…. most are asymptomatic

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16
Q

describe renal cortical cysts

when does prevalence increase

A

benign cysts of unknown etiology located ONLY in the cortex

prevalence increases with age (found in half of patients over 50)

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17
Q

do renal cortical cysts require a follow up

A

no

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18
Q

do most renal cortical cysts cause symptoms

A

no

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19
Q

when must a complex cyst be presumed malignant until proven otherwise

A

if septations are irregular, >1mm thick, or solid elements are present

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20
Q

do genetic conditions usually effect the body in a unilateral or bilateral fashion

A

always bilateral (if there are 2 organs)

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21
Q

is polycystic kidney disease (PKD) genetic

A

yes

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22
Q

2 types of PKD

A

autosomal dominant PKD (ADPKD)

autosomal recessive PKD (ARPKD)

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23
Q

what is ADPKD

what is its US appearance

A

most common hereditary renal disorder that manifests in 4th decade

characterized by enlarged kidneys and multiple cysts bilaterally

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24
Q

how does ADPKD present (signs and symptoms)

A 
palpable mass
pain
hematuria
hypertension (kidneys produce the substances that control this)
UTIs
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25
ADPKD is associated w/ what other anomalies
- cysts in the liver, pan and spleen | - cerebral berry aneurysms (sm round brain aneurysm)
26
what % of patients with ADPKD develop renal failure
50%
27
in general, does ADPKD require very much intervention
no
28
what would be the first lab value to show a change w/ ADPKD | second?
creatinin BUN
29
how should you document ADPKD
get an overall size of the kidneys (best you can), look for any malignant features, document the 2 largest cysts bilaterally.
30
how does the US appearance of ADPKD differ from renal cortical cysts
w/ ADPKD will be multiple and bilateral, effecting all kidney tissue, cortical is only in the cortex and usually unilateral
31
what is ARPKD what is its US appearance
a genetic cystic disease that effects only the pediatric population... there are 4 types. - characterized by very enlarged echogenic kidneys (multiple interfaces) - loss of CM junction - many microscopic cysts.... macroscopic cysts sometimes seen
32
4 types of ARPKD
perinatal neonatal infantile juvenile
33
in younger children w/ ARPKD, which abnormalities are most prominent
renal abnormalities
34
in older children w/ ARPKD, which abnormalities are most prominent
liver abnormalities - portal hypertension
35
all cases of ARPKD are associated w/ what liver condition?
congenital hepatic fibrosis which leads to liver failure
36
all cases of ARPKD will need what type of transplant
liver
37
what are parapelvic cysts what are their orgin
renal cysts located in the renal sinus lymphatic in origin, meaning that there's cystic dilation of lymphatic vessels
38
do parapelvic cysts produce symptoms
most are symptomatic
39
US appearance of parapelvic cysts
well defined cysts that don't connect w/ the renal collecting system, sometimes hard to tell the difference b/w parapelvic cysts and hydro
40
what other testing can be used to differentiate parapelvic cysts from hydro
IVP (xray) or contrast CT
41
best way to differentiate parapelvic cysts from hydro on US
sweep through the kidney well, parapelvic cysts wont connect w/ one another in the sinus but hydro will
42
what is medullary sponge kidney
a dilation (ectasia) of the collecting tubules that manifests in the 3rd and 4th decades and has an unknown etiology
43
medullary sponge kidney is found in what % of people w/ renal stones
12%
44
US appearance of medullary sponge kidney
- bilateral echogenic pyramids w/ normal renal cortex (multiple interfaces) - may see calcifications that are localized to the pyramids
45
what is medullary cystic disease
rare genetic disease that occurs due to progressive renal tubular atropy
46
what are the 2 types of medullary cystic disease
recessive and dominant
47
US appearance of medullary cystic disease
sm echogenic kidneys w/ cysts at the pyramids (0.1 - 1 cm)
48
how to differentiate medullary cystic disease from ARPKS
ARPKD has enlarged kidneys | medullary cystic disease has sm kidneys
49
what is multicystic dysplastic kidney (MCDK)
developmental condition that results from an obstruction of the ureter in utero... causes destruction of the kidney
50
does MCDK effect all genders and sides of the body equally
yes
51
is multicystic dysplastic kidney (MCDK) a hereditary condition
no, developmental
52
what is the most common renal cystic disease in children
multicystic dysplastic kidney (MCDK)
53
US appearance of multicystic dysplastic kidney (MCDK)
- small malformed kidneys w/ multiple communicating cysts - no normal renal architecture - unilateral
54
what happens if multicystic dysplastic kidney (MCDK) effects the body bilaterally when would you see this
its incompatible w/ life you would only see this in utero and the baby would die
55
What are primary congenital cysts
Rare, solitary cysts located in the spleen
56
Do primary congenital cysts produce symptoms
Not usually
57
Another name for primary congenital cysts
Epidermoid cysts
58
Describe the US appearance of primary congenital cysts
Echogenic cystic structure (looks solid) | Internal echos
59
What is a choledochal cyst What is it’s US appearance
Fusiform dilation of the CBD cause by an anomalous insertion of the CBD into the panc duct Cystic structure May contain sludge, stones or solid neoplasms
60
In what population is a choledochal cyst most common
Eastern Asian population | Females
61
A choledochal cyst has a known association w/ what type of carcinoma
Cholangiocarcinoma
62
In general, a choledochal cyst refers to the dilation of which ducts
Extrahepatic (CBD outside this liver)
63
If a choledochal cyst is large, can be hard to see if it connects to the bile duct
Yes
64
What causes sludge, stones or solid neoplasms in a choledochal cyst
Bile stasis
65
What is the most common type of choledochal cyst
Type 1 (fusiform)
66
Describe caroli’s disease What is it US appearance
Rare, congenital dilation of the intrahepatic biliary tree - Saccular or fusiform dilation of the intrahepatic bile ducts that can be diffuse or focal - ducts may contain stones and sludge
67
What effect can caroli’s disease have on the biliary tree
Stasis, stones, cholangitis, sepsis
68
What type of caroli’s disease is the most common
Saccular
69
caroli’s disease is associated w/ which renal conditions
ARPKD and medullary sponge kidney
70
Is cystic fibrosis diagnosed w/ US
No
71
Describe cystic fibrosis What US features would it produce
Genetic condition characterized by exocrine dysfunction Atrophy and increased echogenicity of panc Small cysts that aren’t usually seen on US (only on pathological specimens)
72
Describe peritoneal inclusion cysts
Adhesion trapped ovarian fluid...occurs when the fluid produced by the ovaries is not reabsorbed back into the body due to scar tissue formation caused by a disease process (the fluid gets trapped by the adhesions)
73
What is the US appearance of peritoneal inclusion cysts
Ovary will appear encased in fluid Simple to complex appearance
74
Are peritoneal inclusion cysts more common in men or women
Women
75
Describe mesenteric cysts What are their US appearance
Rare, intra abdo cysts that are usually found incidentally on US Variable in appearance and size
76
What is the typical origin of mesenteric cysts
Lymphatic or mesothelial origin
77
Can you easily differentiate b/w mesenteric cysts and peritoneal inclusion cysts on US What can help you
Not easily. HX can help
78
Describe a GI duplication cyst What is its US appearance
Well defined cyst w/ a double layered wall
79
What are the 2 layers of a GI duplication cyst and how do they look on US
Inner: mucosal layer (echogenic) Outer: muscular layer (hypoechoic)
80
How can you differentiate b/w a GI duplication cyst and a mesenteric cyst
Look for the distinct layers that a GI cyst would have
81
Describe a degenerative prostatic cyst
Most common type of prostate cyst, usually found in the transitional zone (the zone typically effected by BPH)
82
Do degenerative prostatic cysts have clinical significance
No
83
Describe congenital prostatic cysts What conditions are they associated w/
Mostly asymptomatic cysts associated w/ infertility and hematospermia
84
4 types of congenital prostatic cysts
Utricle Müllerian duct Ejaculatory duct Seminal vesicle
85
Describe a prostatic utricle cyst What type of agenesis is it associated w/
Small, Mildline cyst Unilateral Renal agenesis
86
Describe a prostatic mullerian duct cyst Does it contain sperm
Teardrop shaped, usually found laterally Does not contain sperm
87
Describe a prostatic ejaculatory duct cyst Does it contain sperm
Fusiform shape Does contain sperm
88
Are prostatic ejaculatory duct cysts associated w/ infertility
Yes
89
Describe a prostatic seminial vesicle cyst What type of agenesis is it associated w/
Cyst on the seminal vesicles Ipsilateral renal agenesis
90
If a prostatic seminial vesicle cyst is large, is ipsilateral renal agenesis more or less likely
More likely
91
What type of information can we use to correlate w/ US findings of cysts
Lab tests Aspirations Biopsies Other imaging modalities
92
Elevated LFTs are associated will which cystic conditions
ARPKD, Caroli’s, choledocalcysts
93
Why would you aspirate a cyst
To relieve pressure
94
What are the treatments for cystic conditions
Aspiration Alcohol ablation Surgical removal Organ transplant (ARPKD/ADPKD)
95
How does alcohol ablation of a cyst work
Aspirate the cyst and fill it w/ a bit of alcohol... this will irritate the cyst walls and cause them to stick together and ablate the cyst
96
What are the 2 types of carolis disease
Saccular and fusiform
97
Are choledochal cysts congenital
Yes

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