Renal Cysts Revisi
Transcript of Renal Cysts Revisi
![Page 1: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/1.jpg)
![Page 2: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/2.jpg)
SIMPLE KISTA Simple kista > 50% dari
populasi > 50 years, karena obstruksi dari tubulus patau duktus.
Biasanya gejalanya asimtomatik; hematuria ( ruptur kista).
Efek dari kista yang membesar menyebabkan rasa sakit dan rasa tidak nyaman
![Page 3: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/3.jpg)
Radiographic features , IVP:
Lucent defect
Cortical bulge
"Beak sign" can be seen with large cysts.
![Page 4: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/4.jpg)
Radiographic features , US:
Anechoic
Enhanced through-transmission
Sharply marginated,smooth walls
![Page 5: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/5.jpg)
Radiographic features , CT:
Smooth cyst wall
Sharp demarcation
Homogenous Water density (< 10-15 HU)
No significant enhancement after IV contrast (<5HU)
Cyst wall too thin to be seen by CT
![Page 6: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/6.jpg)
Be Careful:
Cysts that contain calcium, septations, and irregular margins (complicated cysts)need further workup
True renal cysts should always be differentiated from hydronephrosis, calycealdiverticulum, and peripelvic cysts.Differentiate renal cyst from hypoechoic renal artery aneurysm using color Doppler US and Angiography
![Page 7: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/7.jpg)
Hydronephrosis:
![Page 8: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/8.jpg)
Calyceal Diverticulum
Parapelvic Cyst
![Page 9: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/9.jpg)
Renal Artery Aneurysm
![Page 10: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/10.jpg)
Complicated CYSTS
Complicated cysts are cysts that do not meet the criteria of simple cysts and thus require further workup.
![Page 11: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/11.jpg)
Bosniak Classification:
Category (Bosniak) US Features Workup
Type 1: Simple cyst Round, anechoic, thin wall enhanced through transmission
None
Type 2: Mildly complicated cyst
Thin septation, calcium in wall
CT or US follow-up
Type 3: Indeterminate lesion
Multiple septae, internal echos mural nodules
Thick septae
Partial nephrectomy, biopsy
CT follow-up if surgery ishigh risk
Type 4: Clearly malignant
Solid mass component Nephrectomy
![Page 12: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/12.jpg)
Increased CT density (> 15 HU) of cyst contentVast majority of these lesions are benign.High density is usually due to hemorrhage, high protein content, and/or calcium.
Radiographic Features of Complicated CystsSeptationsThin septa within cysts are usually benign.Thick or irregular septa require workup.CalcificationsThin calcifications in cyst walls are usually benign.Milk of calcium: collection of small calcific granules in cyst fluid: usually benign
Thick wallThese lesions usually require surgical exploration.
![Page 13: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/13.jpg)
Simple renal cyst, Bosniak Category I.
![Page 14: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/14.jpg)
Bosniak Category II cyst
Curvilinear calcification within a thin septum
![Page 15: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/15.jpg)
Bosniak Category II cyst
Homogeneously hyperdense mass No increase in Density after IV contrast
![Page 16: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/16.jpg)
Bosniak Category II cyst
Cyst with several internal septations and a minimally thickened wall
![Page 17: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/17.jpg)
Bosniak Category II cyst.
Cyst with uniform, mild wall thickening and short, interrupted calcifications
![Page 18: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/18.jpg)
Bosniak Category II hyperdense cyst.
![Page 19: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/19.jpg)
Bosniak Category II cyst
![Page 20: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/20.jpg)
Bosniak Category II cyst.
Nearly completely calcified mass with no obviousenhancing elements
![Page 21: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/21.jpg)
Bosniak Category II.
subcentimeter rim calcified renal cyst
![Page 22: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/22.jpg)
Bosniak Category III.
cystic mass with irregular wall thickening andassociated heterogeneous nonenhancing elements
![Page 23: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/23.jpg)
Bosniak Category III complex cyst.
multilocular, encapsulated mass
![Page 24: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/24.jpg)
Bosniak Category III complex cyst.
Thick-walled, encapsulated, multilocular cystic mass with enhancing septa
![Page 25: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/25.jpg)
Bosniak Category IV cystic neoplasm.
![Page 26: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/26.jpg)
Bosniak Category IV cystic neoplasm
![Page 27: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/27.jpg)
A 42-year-old female with back pain, hematuria, and a renal mass discovered by lumbar spine MR. hyperdense (55 HU) 3 cm mass.
enhance to 88 HU after IV contrast
Renal cell carcinoma
![Page 28: Renal Cysts Revisi](https://reader033.fdocuments.us/reader033/viewer/2022061303/54f736304a79593f188b48bc/html5/thumbnails/28.jpg)
Thank you
Thank you