Cystic Structures Flashcards
Congenital vs. Acquired cyst
Congenital: epithelial lining, developmental, multiple cysts in one organ
Acquired: no epithelial wall, age, infection (abscess), history, signs/symptoms
Does a complex cyst need follow up?
Yes to rule out malignancy
Describe a simple cyst.
Anechoic, strong back wall, posterior acoustic enhancement, oval/round
Describe a complex cyst.
Internal echoes, septations, calcifications, thick wall
What is the most common organ to find cysts in?
Kidneys
Renal cortical cysts
Simple have increasing incidence with age, complex >1mm septations
What are the 2 types of poly cystic kidney disease?
Autosomal dominant and autosomal recessive
What is the most common hereditary renal disorder?
ADPKD
ADPKD
40y/o, associated with cerebral berry aneurysms, liver, pancreas, splenic cysts
Presentation of ADPKD
Palpable, pain, hematuria, hypertension, UTI’s
Sonographic appearance of ADPKD
Renal enlargement (severe), multiple cysts bilaterally
What lab tests would be abnormal with ADPKD?
Creatinine, BUN
4 types of ARPKD?
Perinatal
Neonatal
Infantile
Juvenile
What are all cases of ARPKD associated with?
Congenital hepatic fibrosis
Sonographic appearance of ARPKD
Massively enlarged echogenic kidneys, loss of tissue differentiation, macroscopic cysts noted occasionally
Parapelvic Cysts
Cystic dilation of lymphatic vessels, located in renal sinus, mostly asymptomatic
Sonographic appearance of parapelvic cysts
Well defined, do not connect with collecting system
What is hydronephrosis sometimes mistaken as?
Parapelvic cysts. - differentiate by IVP or contrast CT
Medullary Sponge Kidneys
Dilated collecting tubules, 30-40 y/o, unknown etiology
Sonographic appearance of medullary sponge kidneys
Bilaterally echogenic pyramids, calcifications may be present localized to pyramids
Medullary Cystic Diseases
Results of progressive renal tubular atrophy, genetic
Sonographic appearance of medullary cystic diseases
Small echogenic kidneys with cysts at pyramids
What is the most common renal cystic disease in children???
Multicystic Dysplastic Kidneys
How do multicystic dysplastic kidneys form?
Obstruction of ureter in utero
Sonographic appearance of multicystic dysplastic kidneys
Small, malformed, multiple non-communicating cysts, absence of normal architecture, unilateral
What is another name for primary congenital cysts?
Epidermis cyst
What does an primary congenital cyst affect?
Spleen
Primary congenital cysts
Affect the spleen, echogenic cystic structure, internal echoes, asymptomatic, aka: epidermoid cysts
What is Choledochal cysts associated with?
Cholangiocarcinoma
What is a choledochal cyst?
Fusiform dilation of CBD (tapers at ends)
Sonographic appearance of choledochal cysts
Cystic structure, may contain sludge or stones, can be difficult to identify the connection to the bile duct
Caroli’s disease
Rare, congenital, dilation of intrahepatic biliary tree, results in stains, stones, cholangitis and sepsis
Sonographic appearance of caroli’s disease
Saccular or fusiform dilation of intraheptatic bile ducts, most often diffuse, dilated ducts contain stones and sludge
What can increase the chances of having ARPKD and medullary sponge?
Having Caroli’s disease
What does saccular mean?
Tube with bubble on top opposite to fusiform where there is a bulge and tapers on ends
Cystic Fibrosis
Genetic, excocrine dysfunction, increased echogenicity, atrophy, small cysts but uncommonly seen on u/s
Inclusion cysts
Cysts in abdominal cavity - fluid produced by ovaries gets trapped over time in a cyst that encases the ovary
Mesenteric cysts
Intra-abdominal mass, variable in size, simple or complex
What cyst arises from the wall of the GI tract?
Duplication cyst
Sonographic appearance of duplication cyst
Filled with anechoic fluid, well defined, double layered wall, mucosal layer is echogenic, muscle is hypoechoic
What is the most common prostatic cyst?
Degenerative in transitional zone
What cyst can be associated with infertility?
Congenital prostatic cyst
What are the types of congenital prostatic cysts?
Utricle - unilateral renal agenesis, teardrop shape
Müllerian duct - no spermatozoa, tear drop shape
Ejaculatory duct- fusiform, infertility
Seminal vesicles - Ipsilateral renal agenesis
What lab tests would be abnormal with liver cysts?
LFT, WBC
Treatment
Aspiration, alcohol ablation, surgical removal, organ transplant
What renal disease results from dilated collecting tubules?
Medullary sponge kidney
Which renal cystic disease is of lymphatic origin?
Parapelvic cyst
What will most likely have elevated serum creatinine levels?
ADPKD
