Cystic Structure Flashcards
What is a cyst?
Walled off collection of fluid
What defines a true cyst? 2
- Epithelial lining
- Congenital
What defines a acquired cyst? How does it form? 3
- No epithelial wall
- Trauma
- Infection
What are two types of congenital cysts? 2
- Hereditary
- Developmental
What determines infection in terms of acquired cysts? 2
- Parasitic symptoms
- Inflammatory - abscess
How can true cyst occur in organs? 2 (amount)
- Multiple cysts in one organ
- Multiple organs with cysts
What questions helps determine a acquired cyst? 3
- History
- Signs
- Symptoms
Why is sonographic appearance important for cysts? 3
- Helps direct course of treatment for patient
- A simple cyst does not need follow up
- A complex cyst requires further testing or follow- up to rule out malignancies
How do we describe a simple cyst? 4
- Anechoic
- Strong back wall
- posterior acoustic enhancement
- Oval or round (refractive edge shadow)
How would we describe a complex (atypical) cysts? 4
- Internal echoes
- Septations
- Calcifications
- Thick wall or mural nodularity
What does age do for cysts?
Increase the occurrence
Which organs does cysts increase in odds for in terms of occurrence?
Liver and kidneys
Cysts are a common find during what type of scan?
Abdominal scan
Cysts can be what kind of finding on a scan?
Incidental finding
Finding several cysts in a patient can indicate what?
Genetic abnormality
How would a cyst affect a patient? 6
- It can be asymptomatic
- Pain
- Pressure
- Increased lab values
- Jaundice
- Fever
In terms of how a cyst can affect a person, what can it be dependent on? 3 (what are things that affect how they affect someone)
- Number
- Size
- Location
What are the two main categories of renal cortical cyst?
Simple and complex
Are simple renal cortical cysts benign?
Yes
What is the pathogenesis of simple renal cortical cysts? ( Etiology)
Unknown
What is the incidence rate in correlation with age for simple renal cortical cysts?
They increase with age
What demographic typically is affected by simple renal cortical cysts?
Found in 50% of people over the age of 50
Are simple renal cortical cysts symptomatic?
They are mostly asymptomatic
What happens if we find a simple renal cortical cyst?
They require no follow up
What happens if we see complex renal cortical cysts?
Typically they require further imaging with CT
What would we see that would typically determine if a renal cortical cyst is complex? 2
- If septations are irregular and >1mm in thickness
- Solid elements are present
In terms of a complex renal cortical cysts, when would we consider the lesion non malignant?
Until it is proven otherwise
basically it is a good idea to interrogate the cyst with colour until and watch for colour flow
What do these images represent?
Simple renal cortical cysts
What do these images represent?
Complex renal cortical cysts
What does polycystic kidney cysts mean?
cysts that you are born with
What are the two types of polycystic kidney disease?
- Autosomal dominant
- Autosomal recessive
Which type of polycystic kidney disease is most common?
Autosomal dominant polycystic kidney disease
When does autosomal dominant PKD general manifest?
In the 4th decade of life (40s)
What are some associated anomalies of autosomal dominant PKD? (What organ systems it gets affects) 4
- Liver
- Pancreas
- Splenic cysts
- Cerebral berry aneurysms
50% of patients with Autosomal dominant PKD develop what?
Renal failure
What signs and symptoms does autosomal dominant PKD usually present with? 5
- Palpable mass
- Pain
- Hematuria
- Hypertension
- UTIs
What does Autosomal dominant PKD look like sonographically? 2
- Renal enlargement
- Multiple cysts bilaterally
Where does the multiple cysts present sonographically for autosomal dominant PKD? 2
- Cortical
- Medullary
What does this image demonstrate?
Autosomal dominant PKD
What are four types of autosomal recessive PKD?
- Perinatal
- Neonatal
- Infantile
- Juvenile
What abnormalities are more prominent in young children for autosomal recessive PKD?
Renal abnormalities are more prominent
What abnormalities are more prominent in older children in terms of autosomal recessive PKD?
Liver abnormalities - portal hypertension
All cases of ARPKD are associated with what?
Congenital hepatic fibrosis
What does Autosomal recessive polycystic kidney disease look like sonographically? 3
- Massively enlarged echogenic kidneys
- Loss of CM differentiation
- Macroscopic cysts noted occasionally
What does this image demonstrate? Why?
Autosomal recessive polycystic kidney disease
Note the following
1. Massively enlarged echogenic kidneys
2. Loss of CM differentiation
3. Macroscopic cysts noted occasionally
Where do parapelvic cysts originate likely?
Lymphatic origin
Where are parapelvic cysts located?
In the renal sinus
Are parapelvic cysts symptomatic or asymptomatic?
Mostly asymptomatic
What is the sonographic appearance of parapelvic cysts?
- Well defined
- Do no connect with the collecting system
What tests do we do to differentiate between multiple parapelvic cysts and hydronephrosis?
IVP or contrast CT
What are these images demonstrating?
Parapelvic cysts
What are medullary sponge kidneys?
Kidneys with dilated (ectatic) collecting tubules
What is the etiology of medullary sponge kidneys?
Etiology is unknown
When does medullary sponge kidneys manifest?
3rd and 4th decade
Medullary sponge kidneys is found in 12% of patients with what? (s/s)
Stones
What is the sonographic appearance of medullary sponge kidneys? 2
- Bilaterally echogenic pyramids
- Calcs may be present - localized to pyramids
What does these images demonstrate?
Medullary sponge kidneys
Medullary cystic diseases are a result of what typically?
Progressive renal tubular atrophy
Are medullary cystic disease genetic disorders?
Yes, Both recessive and dominant forms
What does medullary cystic disease look like sonographically?
Small echogenic kidneys with cysts (0.1 - 1cm) at the pyramids
What is the most common renal cyst disease in children?
Multicystic dysplastic kidneys
Are multicystic dysplastic kidneys a genetic disorder?
No, therefore it is a nonhereditary disease
When does multicystic dysplastic kidneys usually occur?
Developmental phase (obstruction of ureter in utero)
In terms of demographic what demographic does mutlicystic dysplastic kidneys affect?
Both males and females, right and left equally affected
What does multicystic dysplastic kidneys look like? 3
- Small kidney
- Malformed with multiple non communicating cysts
- Absence of normal architecture
Multicystic dysplastic kidneys are generally __________? Which side(s) affected
Unilateral
If multicystic dysplastic kidneys are bilateral what happens? Where do we generally see this?
- It is incompatible with life
- In utero
Primary congenital cysts are also called what?
Epidermoid cysts
Primary congenital cysts affect what organ?
SPleen
How common are primary congenital cysts?
Rare
What is the echogenic cystic structure of primary congenital cysts? And are they symptomatic or asymptomatic?
- Internal echoes
- Asymptomatic
When we see primary congenital cysts what can be noted about them in terms of amount?
They are typically solitary
Which geographic demographic is generally affected by choledochal cysts?
Eastern Asia
Which demographic of people are affected by choledochal cysts? (Gender)
Females
What organ does the choledochal cysts affect?
CBD
How does Choledochal cysts affect the CBD? (How does it look?)
Fusiform dilation of the CBD
Where does the choledochal cysts insert into?
Anomalous insertion of CBD into pancreatic duct
What tumors is choledochal cysts known to be associated with?
Cholangiocarcinoma
What kind of structure is the choledochal cysts?
It is a cystic structure
The choledochal cysts may contain what? 3
- Sludge
- Stones
- Solid neoplasm
If the choledochal cysts is large, it may difficult to identify the connection to what?
Bile duct
Which type of choledochal cysts is the most common?
Type 1 is the most common, the one with the fusiform dilation of the extrahepatic duct
What does this image represent?
Choledochal cysts
How common is Caroli’s disease?
It is rare
What type of disease is Caroli’s disease?
Congenital
How does Caroli’s disease present? (What does it look like?)
Dilation of the intrahepatic biliary tree
What does Caroli’s disease result in? 4
- Stasis
- Stones
- Cholangitis
- Sepsis
What does Caroli’s disease look like sonographically? 2
- Saccular or fusiform dilation of the intrahepatic bile duct
- Diffuse but may be focal
What is the most common presentation of Caroli’s disease sonographically? (shape wise)
Saccular
What does the dilated ducts of Caroli’s disease contain?
Stones and sludge
What does this image represent?
Caroli’s disease
What kind of disease is cystic fibrosis? (genetic, congenital, acquired etc.)
Genetic
What kind of dysfunction is cystic fibrosis?
Exocrine
What does cystic fibrosis look like sonographically? 2
- Increased echogenicity
- Atrophy
What is seen with cystic fibrosis? (structure)
Small cysts (1-3 mm) on pathology but are uncommonly seen sonographically
What are two types of cysts seen with the peritoneum?
Inclusion cysts and mesenteric cysts
The fluid in the inclusion cysts are produced by what? What are they usually absorbed by?
- Active ovaries
- Usually absorbed by the peritoneum
The fluid balance of inclusion cysts can be upset by what? 5
Diseases that cause adhesions
- Surgery
- Trauma
- PID
- IBD
- Endometriosis
When adhesions trap ovarian fluid, what happens over time?
Inclusion cysts are formed encasing the ovary
What are mesenteric cysts?
Rare intra-abdominal masses
Mesenteric cysts are typically what kind of finding?
Incidental finding
What is the origin of mesenteric cysts typically? 2
- Lymphatic
- Mesothelial orgin
What is the size of mesenteric cysts?
Variable (<1 - >25cm)
Are mesenteric cysts simple or complex cysts?
May be both
What are duplication cysts filled with?
Anechoic fluid
What does duplication cysts look like?
Well defined, double layer wall
What does the walls of the duplication cysts look like?
- Inner echogenic mucosal layer
- Outer hypoechoic muscular layer
What does the double wall of duplication cysts help do?
Help distinguish this particular type of cysts from mesenteric cysts?
What is this cysts?
Duplication cyst
What are the two types of prostatic cysts?
- Degenerative
- Congenital
What is the most common kind of prostatic cyst?
Degenerative
Where are degenerative cysts generally located?
Transitional zone
What is the clinical significance of degenerative prostatic cysts?
No clinical significance
Are congenital prostatic cysts symptomatic or asymptomatic?
Mostly asymptomatic
What is congenital prostatic cysts associated with?
Infertility and hematospermia (blood in seminal fluid)
What are four kinds of prostatic cysts?
- Utricle cysts
- Mullerian duct cysts
- Ejaculatory duct cysts
- Seminal vesicle cysts
Describe utricle cysts in terms of association
Unilateral renal agenesis association
Where are utricle cysts located?
Always midline
What is the shape of utricle cysts?
Teardrop shape
What is the shape of mullerian duct cysts?
Teardrop shape with a thick wall
What is Mullerian duct cysts completely void of?
Spermatozoa
What kind of structure is ejaculatory duct cysts and what is it associated with? 2
- Fusiform structure
- Infertility
What is seminal vesicle cysts associated with?
Ipsilateral renal agenesis
What should lab test values be for cysts?
Lab test could be abnormal
What are some lab test we would look for in terms of cysts? 2
- LFT
- WBC
What are four treatment methods for cysts?
- Aspiration
- Alcohol ablation
- Surgical removal
- Organ transplant
