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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
Q

ADPKD is associated w/ what other anomalies

A
  • cysts in the liver, pan and spleen

- cerebral berry aneurysms (sm round brain aneurysm)

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26
Q

what % of patients with ADPKD develop renal failure

A

50%

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27
Q

in general, does ADPKD require very much intervention

A

no

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28
Q

what would be the first lab value to show a change w/ ADPKD

second?

A

creatinin

BUN

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29
Q

how should you document ADPKD

A

get an overall size of the kidneys (best you can), look for any malignant features, document the 2 largest cysts bilaterally.

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30
Q

how does the US appearance of ADPKD differ from renal cortical cysts

A

w/ ADPKD will be multiple and bilateral, effecting all kidney tissue, cortical is only in the cortex and usually unilateral

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31
Q

what is ARPKD

what is its US appearance

A

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
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32
Q

4 types of ARPKD

A

perinatal
neonatal
infantile
juvenile

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33
Q

in younger children w/ ARPKD, which abnormalities are most prominent

A

renal abnormalities

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34
Q

in older children w/ ARPKD, which abnormalities are most prominent

A

liver abnormalities - portal hypertension

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35
Q

all cases of ARPKD are associated w/ what liver condition?

A

congenital hepatic fibrosis which leads to liver failure

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36
Q

all cases of ARPKD will need what type of transplant

A

liver

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37
Q

what are parapelvic cysts

what are their orgin

A

renal cysts located in the renal sinus

lymphatic in origin, meaning that there’s cystic dilation of lymphatic vessels

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38
Q

do parapelvic cysts produce symptoms

A

most are symptomatic

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39
Q

US appearance of parapelvic cysts

A

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
Q

what other testing can be used to differentiate parapelvic cysts from hydro

A

IVP (xray) or contrast CT

41
Q

best way to differentiate parapelvic cysts from hydro on US

A

sweep through the kidney well, parapelvic cysts wont connect w/ one another in the sinus but hydro will

42
Q

what is medullary sponge kidney

A

a dilation (ectasia) of the collecting tubules that manifests in the 3rd and 4th decades and has an unknown etiology

43
Q

medullary sponge kidney is found in what % of people w/ renal stones

A

12%

44
Q

US appearance of medullary sponge kidney

A
  • bilateral echogenic pyramids w/ normal renal cortex (multiple interfaces)
  • may see calcifications that are localized to the pyramids
45
Q

what is medullary cystic disease

A

rare genetic disease that occurs due to progressive renal tubular atropy

46
Q

what are the 2 types of medullary cystic disease

A

recessive and dominant

47
Q

US appearance of medullary cystic disease

A

sm echogenic kidneys w/ cysts at the pyramids (0.1 - 1 cm)

48
Q

how to differentiate medullary cystic disease from ARPKS

A

ARPKD has enlarged kidneys

medullary cystic disease has sm kidneys

49
Q

what is multicystic dysplastic kidney (MCDK)

A

developmental condition that results from an obstruction of the ureter in utero… causes destruction of the kidney

50
Q

does MCDK effect all genders and sides of the body equally

A

yes

51
Q

is multicystic dysplastic kidney (MCDK) a hereditary condition

A

no, developmental

52
Q

what is the most common renal cystic disease in children

A

multicystic dysplastic kidney (MCDK)

53
Q

US appearance of multicystic dysplastic kidney (MCDK)

A
  • small malformed kidneys w/ multiple communicating cysts
  • no normal renal architecture
  • unilateral
54
Q

what happens if multicystic dysplastic kidney (MCDK) effects the body bilaterally

when would you see this

A

its incompatible w/ life

you would only see this in utero and the baby would die

55
Q

What are primary congenital cysts

A

Rare, solitary cysts located in the spleen

56
Q

Do primary congenital cysts produce symptoms

A

Not usually

57
Q

Another name for primary congenital cysts

A

Epidermoid cysts

58
Q

Describe the US appearance of primary congenital cysts

A

Echogenic cystic structure (looks solid)

Internal echos

59
Q

What is a choledochal cyst

What is it’s US appearance

A

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
Q

In what population is a choledochal cyst most common

A

Eastern Asian population

Females

61
Q

A choledochal cyst has a known association w/ what type of carcinoma

A

Cholangiocarcinoma

62
Q

In general, a choledochal cyst refers to the dilation of which ducts

A

Extrahepatic (CBD outside this liver)

63
Q

If a choledochal cyst is large, can be hard to see if it connects to the bile duct

A

Yes

64
Q

What causes sludge, stones or solid neoplasms in a choledochal cyst

A

Bile stasis

65
Q

What is the most common type of choledochal cyst

A

Type 1 (fusiform)

66
Q

Describe caroli’s disease

What is it US appearance

A

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
Q

What effect can caroli’s disease have on the biliary tree

A

Stasis, stones, cholangitis, sepsis

68
Q

What type of caroli’s disease is the most common

A

Saccular

69
Q

caroli’s disease is associated w/ which renal conditions

A

ARPKD and medullary sponge kidney

70
Q

Is cystic fibrosis diagnosed w/ US

A

No

71
Q

Describe cystic fibrosis

What US features would it produce

A

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
Q

Describe peritoneal inclusion cysts

A

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
Q

What is the US appearance of peritoneal inclusion cysts

A

Ovary will appear encased in fluid

Simple to complex appearance

74
Q

Are peritoneal inclusion cysts more common in men or women

A

Women

75
Q

Describe mesenteric cysts

What are their US appearance

A

Rare, intra abdo cysts that are usually found incidentally on US

Variable in appearance and size

76
Q

What is the typical origin of mesenteric cysts

A

Lymphatic or mesothelial origin

77
Q

Can you easily differentiate b/w mesenteric cysts and peritoneal inclusion cysts on US

What can help you

A

Not easily.

HX can help

78
Q

Describe a GI duplication cyst

What is its US appearance

A

Well defined cyst w/ a double layered wall

79
Q

What are the 2 layers of a GI duplication cyst and how do they look on US

A

Inner: mucosal layer (echogenic)

Outer: muscular layer (hypoechoic)

80
Q

How can you differentiate b/w a GI duplication cyst and a mesenteric cyst

A

Look for the distinct layers that a GI cyst would have

81
Q

Describe a degenerative prostatic cyst

A

Most common type of prostate cyst, usually found in the transitional zone (the zone typically effected by BPH)

82
Q

Do degenerative prostatic cysts have clinical significance

A

No

83
Q

Describe congenital prostatic cysts

What conditions are they associated w/

A

Mostly asymptomatic cysts associated w/ infertility and hematospermia

84
Q

4 types of congenital prostatic cysts

A

Utricle
Müllerian duct
Ejaculatory duct
Seminal vesicle

85
Q

Describe a prostatic utricle cyst

What type of agenesis is it associated w/

A

Small, Mildline cyst

Unilateral Renal agenesis

86
Q

Describe a prostatic mullerian duct cyst

Does it contain sperm

A

Teardrop shaped, usually found laterally

Does not contain sperm

87
Q

Describe a prostatic ejaculatory duct cyst

Does it contain sperm

A

Fusiform shape

Does contain sperm

88
Q

Are prostatic ejaculatory duct cysts associated w/ infertility

A

Yes

89
Q

Describe a prostatic seminial vesicle cyst

What type of agenesis is it associated w/

A

Cyst on the seminal vesicles

Ipsilateral renal agenesis

90
Q

If a prostatic seminial vesicle cyst is large, is ipsilateral renal agenesis more or less likely

A

More likely

91
Q

What type of information can we use to correlate w/ US findings of cysts

A

Lab tests
Aspirations
Biopsies
Other imaging modalities

92
Q

Elevated LFTs are associated will which cystic conditions

A

ARPKD, Caroli’s, choledocalcysts

93
Q

Why would you aspirate a cyst

A

To relieve pressure

94
Q

What are the treatments for cystic conditions

A

Aspiration
Alcohol ablation
Surgical removal
Organ transplant (ARPKD/ADPKD)

95
Q

How does alcohol ablation of a cyst work

A

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
Q

What are the 2 types of carolis disease

A

Saccular and fusiform

97
Q

Are choledochal cysts congenital

A

Yes

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