Radiology 6217 Background TAF 41 year old male H istory of IBS now presenting as an outpatient with RUQ pain diarrhea weight loss Initial Ddx and workup Differential diagnosis Gallstones ID: 682798
Download Presentation The PPT/PDF document "Renal Cysts Surbhi Gupta, ms4" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Renal Cysts
Surbhi Gupta, ms4
Radiology
6/2/17Slide2
Background
TAF, 41 year old male
H
istory of IBS, now presenting as an outpatient with RUQ pain, diarrhea, weight lossSlide3
Initial Ddx
and workup
Differential diagnosis
Gallstones
IBS flare
IBD
Pancreatitis
Hepatitis
Peptic ulcer disease
Workup
Vitals: stable, normal
Physical exam: normal
Labs
: within normal C
BC
, CMP, viral panel
RUQ u/s: hypoechoic right renal upper pole mass
CTSlide4
2-5 imagesSlide5Slide6
Parameters and New ddx
Lesion parameters
Largest two lesions reaching 25mm
Average Hounsfield units 30-45
No enhancement
New Differential Diagnosis
Renal cysts
NeoplasmSlide7
Bosniak Classification
Features
Work-up
Malignancy
1
Thin-walled,
r
ound
None
0%
2
Few
septae
, fine calcifications, <3cm, non-enhancing
None
0%2FMore septae, thick calcifications, >3cm, non-enhancingFollow with u/s or CT5%3Thick and irregular septae, can be enhancing (+10-20 HU)Nephrectomy or radiofrequency ablation55%4Solid with cystic or necrotic elementsNephrectomy100%Slide8
Renal cysts overview
Found in 50% of people over the age of 50
Unclear pathogenesis
Complications
Infection
Ischemia
Hemorrhage
P
ain
Management
Dx
: ultrasound with Doppler, CT
Tx
: if symptomatic, ultrasound guided sclerotherapy vs laparoscopic cystectomy Slide9
Final diagnosis
Bosniak
class II cysts
No intervention or follow up recommended
Treatment with gut hypnotherapy and acupuncture for IBSSlide10
References
Cecil
G. Wood III, LeRoy J. Stromberg III, Carla B.
Harmath
, Jeanne M. Horowitz, Chun Feng, Nancy A. Hammond, David D.
Casalino
, Lori A.
Goodhartz
, Frank H. Miller, and Paul
Nikolaidis
.
CT and MR Imaging for Evaluation of Cystic Renal Lesions and
Diseases.
RadioGraphics
2015 35:1,
125-141.Muglia, Valdair F., and Antonio Carlos Westphalen. “Bosniak Classification for Complex Renal Cysts: History and Critical Analysis.” Radiologia Brasileira 47.6 (2014): 368–373. PMC. Web. 1 June 2017.http://www.radiologyassistant.nl/en/p44d1045b472df/kidney-cystic-masses.html