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ABD 313 > Cystic Diseases > Flashcards

Cystic Diseases Flashcards

1
Q

What is a cyst?

A

A walled-off collection of fluid.

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2
Q

What is the main difference between true and acquired cysts?

A

True cysts have an epithelial wall and acquired cysts do not.

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3
Q

When are true cysts formed?

A

Congenital

  1. Hereditary
  2. Developmental
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4
Q

How are acquired cysts formed? (4)

A
  1. Post traumatic (even just aging)
  2. Infectious process
  3. Parasitic
  4. Inflammatory (abscesses)
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5
Q

What features indicate that a cyst is “true”? (2)

A
  1. Multiple cysts in one organ

2. Multiple organs with cysts

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6
Q

What features indicate that a cyst is “acquired”?

A

History/signs/symptoms that indicate trauma, pain, infection or inflammatory processes.

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7
Q

What are the 4 sonographic criteria for a simple cyst?

A
  1. Anechoic
  2. Strong back wall
  3. Posterior acoustic enhancement
  4. Oval or round (refractive edge shadow)
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8
Q

What are the sonographic features of a complex cysts? (4)

A
  1. Internal echoes
  2. Septations
  3. Calcifications
  4. Thick wall or mural nodularity
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9
Q

What do internal echoes in a cyst indicate?

A

Hemorrhage or infection

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10
Q

What do septations in a cyst indicate? (4)

A

Malignancy, hemorrhage, infection or adjacent cysts

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11
Q

What do calcifications in a cyst indicate? (3)

A

Malignancy, Inflammatory reactions or milk of calcium

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12
Q

What do thick walls or mural nodularity in a cyst indicate?

A

Malignancy or benign thickening

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13
Q

What increases the occurrence of cysts (especially in the liver and kidneys)?

A

Age

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14
Q

What can multiple cysts indicate?

A

A genetic abnormality

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15
Q

What do the effects of cysts depend on?

A

The number, size and location

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16
Q

What are the possible effects of cysts?

A
  1. Asymptomatic
  2. Pain
  3. Pressure
  4. Increased lab values
  5. Jaundice
  6. Fever
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17
Q

What lab values would be increased by cysts?

A

Increased WBC’s (if the cyst is infected).

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18
Q

What lab values may be decreased in the presence of large liver cysts?

A

Decreased LFT’s

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19
Q

What type of cysts are found in the cortex of the kidneys?

A

Renal Cortical Cysts

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20
Q

Are Simple Renal Cortical Cysts concerning?

A

No, they may increase with age but they are typically benign and asymptomatic so they do not require follow-up.

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21
Q

Look at images of simple Renal Cortical Cysts in slides.

A

….

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22
Q

What defines septations as irregular?

A

Greater than 1 mm in thickness or solid elements.

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23
Q

Does a complex cyst with septations require further imaging?

A

Yes, if the septations are irregular then the lesion must be presumed malignant until proven otherwise.

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24
Q

Look at the images of the complex Renal Cortical Cysts in the slides.

A

…

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25
Q

What are the two types of polycystic kidney disease?

A
  1. Autosomal dominant

2. Autosomal recessive

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26
Q

What is ADPKD?

A

Autosomal Dominant Polycystic Kidney Disease

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27
Q

What is the most common hereditary renal disorder?

A

ADPKD

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28
Q

When does ADPKD usually manifest?

A

The 4th decade

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29
Q

What are the anomalies associated with ADPKD?

A
  1. Cerebral berry aneurysms

2. Liver, pancreas, splenic cysts

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30
Q

How often do patients with ADPKD develop renal failure?

A

50%

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31
Q

What are the signs/symptoms of ADPKD?

A
  1. Palpable mass
  2. Pain
  3. Hematuria
  4. Hypertension
  5. UTI’s
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32
Q

What is the sonographic appearance of ADPKD?

A

Renal enlargement and multiple cortical and medullary cysts bilaterally.

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33
Q

What lab tests would be affected by ADPKD?

A

Creatinine and BUN LFT

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34
Q

With respect to the kidneys, how does ADPKD differ from a cortical cyst?

A

There are multiple cysts seen in both the medulla and cortex.

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35
Q

What is ARPKD?

A

Autosomal Recessive Polycystic Kidney Disease

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36
Q

What do the different types of ARPKD depend on?

A

Age

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37
Q

What are the 4 types of ARPKD??

A
  1. Perinatal
  2. Neonatal
  3. Infantile
  4. Juvenile
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38
Q

What type of PKD is more serious?

A

Autosomal Recessive

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39
Q

What abnormalities are more prominent in younger children with ARPKD?

A

Renal abnormalities

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40
Q

What abnormalities are more prominent in older children with ARPKD?

A

Liver abnormalities (portal hypertension).

41
Q

What disease is associated with all types of ARPKD?

A

Congenital Hepatic Fibrosis

42
Q

What is the sonographic appearance of ARPKD?

A
  1. Massively enlarged echogenic kidneys
  2. Loss of cortex/medulla differentiation
  3. Macroscopic cysts (occasionally)
43
Q

Look at the images of ADPKD and ARPKD in the slides.

A

…

44
Q

What is the origin of parapelvic cysts?

A

Believed to be lymphatic

45
Q

Where are parapelvic cysts located?

A

In the renal sinus

46
Q

What are the symptoms of parapelvic cysts?

A

Asymptomatic

47
Q

What is the sonographic appearance of parapelvic cysts?

A

Well defined cysts in the sinus that do not connect with the collecting system.

48
Q

What is used to differentiate between multiple parapelvic cysts and hydronephrosis?

A

Intravenous Pyelogram (X-ray) or contrast CT

49
Q

What kidney condition is due to dilated collecting tubules?

A

Medullary Sponge Kidneys

50
Q

What does ectatic mean?

A

Dilated or distended

51
Q

What is the etiology of medullary sponge kidneys and when does it manifest?

A

Unknown etiology, manifests in the 3rd and 4th decade.

52
Q

How often is medullary sponge kidney found in patients with renal stones?

A

12%

53
Q

What is the sonographic appearance of medullary sponge kidneys?

A

Bilaterally echogenic pyramids that may have calcifications localized to the medullary pyramids.

54
Q

Look at the images of medullary sponge kidneys.

A

…

55
Q

What is Medullary Cystic Disease?

A

It is a genetic disease that is the result of progressive renal tubular atrophy.

56
Q

What forms does Medullary Cystic Disease have?

A

Recessive and Dominant

57
Q

What is the sonographic appearance of Medullary Cystic Disease?

A

Small, echogenic kidneys with cysts at the pyramids measuring 0.1 - 1.0 cm.

58
Q

What is MCDK?

A

Multicystic Dysplastic Kidney

59
Q

What is Multicystic Dysplastic Kidney?

A

It is a non-hereditary, developmental condition due to an obstruction of a ureter in utero.

60
Q

Who is most effected by Multicystic Dysplastic Kidney?

A

Both males and females, (left and right kidneys) are equally effected.

61
Q

What happens if Multicystic Dysplastic Kidney is bilateral?

A

The fetus is incompatible with life and will not survive.

62
Q

What is the sonographic appearance of Multicystic Dysplastic Kidney? (3)

A
  1. Small, malformed kidney unilaterally
  2. Multiple non-communicating cysts
  3. Absence of normal renal architecture
63
Q

What is another name for Primary Congenital Cysts?

A

Epidermoid cysts of the spleen

64
Q

What are primary congenital Cysts?

A

Rare, asymptomatic cyst of the spleen that is completely filled with echogenic internal echoes

65
Q

What is a Choledochal Cyst?

A

A fusiform dilation of the extra hepatic bile duct (CBD) caused by an anomalous insertion of the CBD into the pancreatic duct.

66
Q

Who does Choledochal cysts primarily effect?

A

Women in the east asian populaton.

67
Q

What do Choledochal cysts have an association with?

A

Cholangiocarcinoma

68
Q

What is the sonographic appearance of Choledochal cysts?

A

A cystic structure that may contain sludge, stones or a solid neoplasm in the area of the CBD.

69
Q

What can be difficult to identify when a choledochal cyst is large?

A

The connection to the bile duct.

70
Q

What is the most common type of choledochal cyst?

A

Type one (fusiform dilation of the extrahepatic duct)

71
Q

What is Caroli’s Disease?

A

A rare congenital disease that causes dilation of the intrahepatic biliary tree

72
Q

What does Caroli’s Disease result in? (4)

A
  1. Stasis
  2. Stones
  3. Cholangitis
  4. Sepsis
73
Q

What is the sonographic appearance of Caroli’s Disease?

A
  1. Saccular or fusiform dilation of the intrahepatic ducts
  2. Often diffuse, may be focal
  3. Dilated ducts may contain stones and sludge
74
Q

What is the difference between saccular and fusiform?

A

Saccular is a bulge (dilation) on one side of the vessel and fusiform is a dilation all around.

75
Q

What other diseases is Caroli’s associated with?

A
  1. Autosomal Polycystic Disease

2. Medullary Sponge Kidneys

76
Q

What is Cystic Fibrosis?

A

A genetic condition involving exocrine dysfunction.

77
Q

What is the sonographic appearance of Cystic Fibrosis?

A
  1. Increased echogenicity of the pancreas
  2. Atrophy of the pancreas
  3. Small cysts (1-3mm) on the pancreas uncommonly seen on US
78
Q

What are Peritoneal Inclusion Cysts?

A

Ovarian fluid trapped by adhesions (scars) that encase the ovary.

79
Q

How do peritoneal inclusion cysts appear?

A

Simple to complex

80
Q

What conditions can cause the adhesions of peritoneal inclusion cysts? (5)

A
  1. Surgery
  2. Trauma
  3. PID
  4. IBD
  5. Endometriosis
81
Q

What are Mesenteric Cysts?

A

Rare cysts that vary in appearance and size that originate from the lymphatic system or mesothelial lining.

82
Q

What are GI duplication cysts?

A

Well defined, double walled cysts that are filled with anechoic fluid.

83
Q

What are the layers of the GI Duplication cysts?

A

Inner layer = mucosal layer

Outer layer = Muscular layer

84
Q

What are Degenerative Prostatic Cysts?

A

Cysts located in the transitional zone of the prostate

85
Q

What is the most common type of prostate cyst?

A

Degenerative Prostate Cyst

86
Q

Refer to page 369/370 for Degenerative Prostatic Cyst

A

…

87
Q

What are Congenital Prostatic Cysts?

A

Mostly asymptomatic cysts around the prostate that are associated with infertility and hematospermia.

88
Q

What are the types of Congenital Prostatic Cysts? (4)

A
  1. Utricle Cyst
  2. Mullerian Duct Cysts
  3. Ejaculatory Duct Cysts
  4. Seminal Vesicle Cysts
89
Q

What Congenital Prostatic Cyst is associated with unilateral renal agenesis?

A

Utricle cyst

90
Q

What Congenital Prostatic Cyst is midline and teardrop shaped?

A

Utricle Cyst

91
Q

What Congenital Prostatic Cyst is teardrop shaped with a thick wall?

A

Mullerian Duct Cysts

92
Q

Do Mullerian Duct Cysts contain spermatozoa?

A

No

93
Q

What shape are ejaculatory duct cysts?

A

Fusiform

94
Q

What do ejaculatory duct cysts contain?

A

Spermatozoa

95
Q

What type of Congenital Prostatic Cyst is associated with infertility?

A

Ejaculatory Duct Cyst

96
Q

What are Seminal Vesicle Cysts associated with?

A

Ipsilateral renal agenesis

97
Q

What is the treatment for cysts?

A
  1. Cyst aspiration
  2. Alcohol ablation
  3. Surgical removal
  4. Organ transplant
98
Q

What other methods are used in correlation with Ultrasound to diagnose cysts?

A
  1. Lab tests (Elevated WBC’s and LFTS)
  2. Aspiration/biopsy
  3. CT/X-ray
99
Q

What are the layers of the bowel wall and their echogenicities?

A
  1. Lumen = hyper
  2. Mucosal = hypo
  3. Submucosal = hyper
  4. Muscularis = hypo
  5. Serosal = hyper

M’s are hypo (5 layers)

ABD 313 (11 decks)

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