Chapter 7-Renal Mass

Question 1

–a progressive hereditary disorder that leads to renal failure; affects 1:1000.

Clinical Symptoms-30s-40’s w/ decreasing renal function and hypertension; may present with abnormalities of the heart valves, colonic diverticula, and cerebral aneuris; symptoms include flank pain and hematuria (cysts are prone to hemorrhage and infection)

Sonographically- multiple cysts of varying sizes noted bilaterally. As the disease progresses, the kidneys become enlarged and present with nephromegaly. Patients younger than 30 should have two renal cysts (uni or bilat), patients 30-59 should have two cysts and patients older than 60 should have 4.

Answer 1

Autosomal Dominant Polycystic Kidney Disease

Question 2

located in the renal sinus and are lymphatic in origin; they do not communicate with the collecting system although may mimic hydronephrosis.
Clinically- asymptomatic Sonographic -cystic area in the sinus of kidney.

Answer 2

Parapelvic cyst

Question 3

progressive disorder that results in chronic renal failure from a noncystic renal disorder characterized by development of multiple cysts
Clinical Symptoms-patients with long-term dialysis. It is usually asymptomatic but patients with secondary complications may have hemorrhage and the development of renal cell carcinoma (RCC) (may include hematuria, flank pain, and fever)
Sonographically-when three or more cysts are identified in each kidney. Kidneys are usually decreased in size but may be enlarged as well.

Answer 3

Acquired Cystic Kidney Disease

Question 4

a cyst that doesn’t meet the criteria of a simple cyst; may exist within the cortex, medulla, or pelvis-
Characteristics-perceptible wall which may include calcification, irregularity, or thickening; internal echoes that may include septations and enhancement.

Answer 4

Characteristics of complex cyst

Question 5

What is the claw sign?

Answer 5

Concavity in the renal cortex in which the parenchyma seems to be cupping the cyst or mass

Question 6

The claw sign is most commonly found with what type of simple cyst?

Answer 6

Cortical

Question 7

Parapelvic cysts are from _____ origin

Answer 7

Lymphatic origin

Question 8

True or false

Parapelvic cysts communicate with the renal collecting system.

Answer 8

False

They do not communicate with renal collecting system

Question 9

Are patients with parapelvic cysts usually

Symptomatic or asymptomatic

Answer 9

Asymptomatic

Question 10

If there is multiple parapelvic cysts what could it be mistaken with?

Answer 10

Hydronephrosis

Question 11

When a cyst does not meet the criteria of a simple cysts, what is it then called?

Answer 11

Complex cyst

Question 12

Where can a complex cyst exist?

Answer 12

Cortex medulla or pelvis

Question 13

What are the common findings of a complex cyst

3 things

Answer 13

Perceptible wall
Internal echoes
Variable enhancement

Question 14

Name a few types of complex cysts

Answer 14

Hemorrhagic
Infected cyst
Multilocular or septated cyst
Calcified cysts
Cyst malignancy

Question 15

What would the symptoms of a patient with a hemorrhagic cyst be?

Answer 15

Flank pain and hematuria

Question 16

If the patient has an infected cyst, what would their symptoms be?

Answer 16

Flank pain

Fever

Hematuria
white blood count

KEY WORD IS WHITE BLOOD COUNT-dead giveaway that the patient has infection

Question 17

Sonographic findings of an infected cyst?

Answer 17

Debri (low level echoes)

Debri may have a layer effect that changes LLD.

Thickened wall

Question 18

A cyst that contains septations or locultions are?

Answer 18

Multilocular cysts

Question 19

Where do the septations come from?

Answer 19

Resolved hemorrhage or infection

Question 20

Thin septations usually are fine although aspiration should be used to rule out ______.

Answer 20

Malignancy

Question 21

If the septation is thick and shows papillary projections, ____ should be suspected.

Answer 21

Malignancy

Question 22

Calcifications can occur if the cyst had previously been _______ or ______

Answer 22

Infected or hemorrhaged

Question 23

Thick calcifications can be worrisome of ________

Answer 23

Malignancy

Question 24

Milk in calcium frequently occurs in patients with______ ???

Answer 24

Calyceal diverticulum

Question 25

Urine stasis in the diverticulum leads to the formation of….

Answer 25

Milk of calcium

Question 26

What are some types of cyst malignancy

Answer 26

Cystic nephroma or cystic renal cell carcinoma