Renal cysts

Question 1

How are cysts categorized?

Answer 1

size
location
septations
calcifications
contents
enhancement

Question 2

What is the most common type of renal mass?

Answer 2

Simple renal cyst

Question 3

What is the most common age group for simple renal cysts and how are they most commonly found?

Answer 3

> 70 yo

MC incidental finding

Question 4

Are patients with simple renal cysts more at risk for HTN, CA, CKD, or ESRD?

Answer 4

NAHHHH

Question 5

Where do simple renal cysts develop? Characteristics

Answer 5

in the cortex and medulla

solitary or multiple
< 1 cm to > 10 cm
round or oval
lining is simple epithelial layer
fluid filled
Clear to straw-color fluid

Question 6

What is the most common clinical manifestation of simple renal cysts?

Answer 6

Trick question…

they typically produce no clinical manifestations

Question 7

If a pt w/ simple renal cyst were to have rupture, what would the symptoms be?

Answer 7

flank pain and hematuria

Question 8

If a pt w/ simple renal cyst were to have infection leading to renal abscess, what would the symptoms be?

Answer 8

insidious fever
vague limbo-abdominal pain
+/- hematuria or pyuria

Question 9

You need to distinguish simple cysts from what?

Answer 9

complex cysts

Question 10

What are the US criteria for simple cysts

Answer 10

• sharply demarcated w/ smooth thin walls
• no echoes (anechoic) within the mass
• enhanced back wall indicating good transmission through the cyst

Question 11

What are the US criteria for complex cysts

Answer 11

• thick walls &/or separations
• calcifications
• solid components
• mixed echogenicity
• vascularity

Question 12

If US is c/w complex cyst, what needs to be done?

Answer 12

CT w/ and w/o contrast

Question 13

On Bosniak Classifaction, what is category I features and what does it indicate?

Answer 13

features of simple cyst:

• sharply demarcated w/ smooth thin wall
• homogenous fluid
• no contrast enhancement

Means simple cyst!

Question 14

On Bosniak Classifaction, what is category II features and what does it indicate?

Answer 14

• closely resemble simple cyst
• may be few thin septa
• may contain few calcifications
• < 3cm and well demarcated
• no contrast enhancement

complex cyst
bengin

Question 15

If you find a renal cyst that is Bosniak classification of I or II, what needs to be done?

Answer 15

Repeat CT w/ and w/o contrast in 6-12 months

Question 16

• Indeterminate cystic masses
• thickened irregular walls or septa
• measurable enhancement

These are all features of which Bosniak Category? What do they indicate? what needs to be done?

Answer 16

Category III

complex cyst
features are c/w malignancy
monitor or excise