Module 1 : Cystic Diseases Flashcards
definition of a cyst
a walled off collection of fluid
the two types of cysts
true cysts vs acquired cysts
characteristics of true cysts
- epithelial wall
- congenital
+ hereditary or developmental
characteristics of acquired cysts
- no epithelial wall
- post traumatic
- infections
- parasitic
- inflammatory (abscesses)
can we tell the difference between true and acquired cysts
- NO
common features of true cysts
- multiple cysts in one organ
- multiple organs with cysts
common features of acquired cysts
- history = injury or infection
- signs
- symptoms = fever or increased WBC’s
what is the most important thing to determine when scanning cysts and why
- simple or complex
+ helps direct course of treatment
+ simple cyst does not need follow up
+ complex requires further testing or follow up to rule out malignant
the 4 sonographic criteria for a simple cyst
- anechoic
- strong back wall
- POSTERIOR ACOUSTIC ENHANCEMENT
- oval or round = edge shadow
4 characteristics of a complex cyst
- internal echoes \+ hemorrhage or infection - septations \+ malignancy or hemorrhage or infection or adjacent cysts - calcifications \+ malignancy or inflammatory or milk of calcium - thick wall or mural nodularity \+ malignancy or benign thickening
does age increase or decrease number of cyst
increase especially liver and kidney
a genetic abnormality can be indicated by what
finding multiple cyst
6 possible effects of cyst on patient (dependant on number size and location)
- asymptomatic
- pain
- pressure
- increased lab values
- jaundice (pressure on biliary tree)
- fever
renal cortical cysts are found where
- only in the cortex
renal cortical cysts - simple characteristics
- benign
- unknown etiology (idiopathic)
- increase with age (50% of people over 50)
- mostly asymptomatic
- no follow up required
renal cortical cysts - complex characteristics
- does not meet the criteria of a simple cyst
- require further imaging
- if septations are irregular, >1mm in thickness or solid elements present LESIONS ARE PRESUMED MALIGNANT UNTIL PROVEN OTHERWISE
what are the 2 types of polycystic kidney disease
- autosomal dominant
- autosomal recessive
autosomal dominant polycystic kidney disease (ADPKD)-manifests when?
- in the fourth decade of life (40’s)
- IT IS THE MOST COMMON HEREDITARY RENAL DISORDER
associated anomalies with ADPKD
- liver, pancreas, and splenic cysts
- cerebral berry aneurysms
is ADPKD unilateral or bilateral d
BILATERAL ALWAYS
which lab tests will be elevated with ADPKD
creatinine and BUN
ADPKD - physical presentation
- palpable mass
- pain
- hematuria
- hypertension (kidney release substance to control blood pressure)
- UTI’s
ADPKD - sonographic appearance
- renal ENLARGMENT
- multiple cysts bilateral
how does the presentation of ADPKD differ from cortical cysts
- there are multiple cyst but in renal cortical cysts = only in cortex
- ADPKD = cysts everywhere
autosomal recessive polycystic kidney disorder (ARPKD) - 4 types that are age dependent
- perinatal = in the womb
- neonatal = new born
- infantile
- juvenile
- ALL CASES MANIFEST IN PEDIATRIC PATIENTS
ARPKD - in younger children which organ is most effected
- renal abnormalities more prominent
ARPKD - in older children which organ is most effected
- liver abnormalities are more prominent (portal hypertension)
ARPKD - associated to what other life threatening disorder
- all cases are associated with congenital hepatic fibrosis
- this will lead to liver failure and transplant will be needed
ARPD - sonographic appearance
- massively ENLARGED
- ECHOGENIC
- loss of CM differentiation
- macroscopic cysts noted occasionally but usually to small for us to see
parapelvic cysts - characteristics
- lymphatic in origin
- located in the renal sinus
- mostly asymptomatic
paraplevic cysts - sonographic appearance
- well defined cysts
- do not collect with collecting system
- IVP or contrast CT can be used to differentiate between multiple paraplegic cysts and hydronephrosis
medullary sponge kidneys - characteristics
- dilated (ectatic) collecting tubules
- unknown cause
- 3rd and 4th decade
medullary sponge kidneys - sonographic appearance
- bilaterally echogenic pyramids
- calcifications may be present
+ localized to medullary pyramids
medullary cystic disease - characteristics
- result of progressive renal tubular atrophy
- genetic
+ recessive and dominant forms
medullary cystic disease - sonographic appearance
- small echogenic
- cysts at pyramids
multi-cystic dysplastic kidney (MCDK) - characteristics
- developmental
+ NOT genetic, obstruction of ureter in utero - non hereditary
- males and females, left and right equally effected
- MOST COMMON RENAL CYSTIC DISEASE IN CHILDREN
MCDK - sonographic appearance
- small, malformed kidney
- multiple non communicating cysts
- absence of normal renal architecture
- UNILATERAL
+ IF BILATERAL = INCOMPATIBLE WITH LIFE - only seen prenataly need one kidney to survive
primary congenital cysts - characteristic
- also called EPIDERMOID CYSTS
- usually of spleen
- rare
- asymptomatic
- solitary
primary congenital cysts - sonographic appearance
- echogenic cystic structure
- internal echos
choledochal cysts - characteristics
- eastern asian pop
- females more
- fusiform dilation of CBD (EXTRAHEPATIC)
- cause by anomalous (unknown) insertion of CBD into panc duct
- known association with cholangiocarcinoma (bile duct cancer)
fusiform
- dilated in the middle but tapers at each end
choledochal cyst - sonographic appearance
- cystic structure
- may contain sludge, stones or solid neoplasm
- if cyst large may be difficult to identify connection to CBD
what is the most common type of choledocal cyst
- type 1 = fusiform
caroli’s disease - characteristics
- rare
- congenital
- DILATION OF INTRAHEPATIC BILIARY TREE
- results in stasis , stones, cholangitis, and sepsis
- has an association with ARPKD and medullary sponge kidneys
caroli’s disease - sonographic appearance
- saccular (out pouching) (MOST COMMON) or fusiform dilation of INTRAHEPATIC DUCTS
- often diffuse but can be focal
- dilated ducts may contain stones and sludge
cystic fibrosis - characteristics
- genetic
- exocrine dysfunction
cystic fibrosis - sonographic appearance
- increased echogenicty of panc
- atrophy
- small cyst on pathology report, uncommonly seen
peritoneal inclusion cysts
- adhesion trapped ovation fluid
- ovary encased within lesion fluid leaks out
- simple to complex
- trapped by lesions caused by inflammatory disease
mesenteric cysts
- rare
- incidental finding
- lymphatic or mesothelial in origin
- variable appearance and size
GI duplication cysts
- filled with anechoic fluid
- well defined double layer wall
+ inner layer = mucosal layer more echogenic
+ outer layer = muscular layer more hypo echoic
degenerative prostatic cysts
- most common
- located in transitional zone (BPH effects here)
- no clinical significance
congenital prostatic cysts
- asymptomatic
- associated with infertility, hematospermia
- effect SV and prostate
utricle cysts
- unilateral renal agenisis
- midline tear drop shape
- usually small but become large
mullerian duct cysts
- no spermatozoa
- tear drop shape
- lateral to midline
ejaculatory duct cysts
- fusiform shape
- contain spermatozoa
- associated with infertility
seminal vesicle cysts
- ipsilateral renal agenesis with increased size of cysts
liver function tests should be abnormal with which types of cysts
- ARPKD, caroli’s, choledocal
WBC abnormal in which situations
- infection
creatinine or BUN abnormal with which cysts
PKD
treatments of cystic disease
- cyst aspiration or alcohol ablation
- surgical removal
- organ transplant
