Simple renal cysts in children: diagnosis and follow-up with US. The prevalence of simple renal and hepatic cysts detected by spiral computed tomography. The natural history of simple renal cysts. Adult renal cystic disease: a genetic, biological, and developmental primer. autosomal recessive polycystic kidney disease (ARPKD).dilated moiety of a duplicated collecting system.some multisystem disorders include multiple renal cysts.lithium-related cysts: multiple tiny cysts.autosomal dominant polycystic kidney disease (ADPKD).In a pediatric patient with normal renal function, no follow up is necessary for an incidentally-discovered renal cyst 4. Percutaneous alcohol ablation has been practised with some success in selected cases of symptomatic cysts 5. Cysts may occasionally rupture, causing pain.Ī symptomatic renal cyst can be aspirated, but cysts have a high rate of recurrence. Simple renal cysts are overwhelmingly asymptomatic, although there have been occasional reports of symptomatic giant cysts causing pain from mass effect on adjacent structures. Renal cystic lesions with postcontrast enhancement and/or restricted diffusion are suggestive of neoplasms and should be viewed with suspicion. It should show appropriate changes in cyst signal intensity (decreased T2, increased T1) and lack of enhancement. MRI may help clarify possible hemorrhagic cysts on ultrasound and CT. DWI: increased signal, but no restricted diffusion.T2: strongly hyperintense (hemorrhagic debris may mildly decrease signal) and separate from the collecting system.T1 C+ (Gd): no postcontrast enhancement.T1: hypointense (hemorrhagic debris may mildly increase signal).Simple cyst characteristics are similar to ultrasound and CT: increasing septation of the cyst, thick wall calcification and wall/septa enhancement are concerning for renal cell carcinoma.hyperattenuating (70-90 HU on non-contrast series).water attenuation (20 HU increase is enhancement.See article: Bosniak classification of renal cysts. This may be improved by using harmonic imaging techniques.Ĭontrast-enhanced ultrasound may be useful to show vascularity of septa or nodular protuberances in a renal cyst and can help differentiate a benign cyst from an indeterminate cyst or a malignant-appearing cyst 7. vascularity of the septa on color or spectral Doppler is suspicious for renal cell carcinomaĪnechoic renal cysts may show some artifactual internal low-level echoes.cystic lesions with thickened or irregular walls or septa are suspicious for renal cell carcinoma and warrant further work up.a small amount of intracystic hemorrhage/debris may be present and may require further evaluation (5% of cysts).posterior acoustic enhancement may be present, although this finding is non-specific and also may not be seen with smaller cysts.a few thin septa may be present (5% of cysts).well-marginated anechoic lesion with thin walls.Incidental renal cysts are present in ~0.2% of pediatric patients 4. The frequency of renal cysts increases with age and they are present in approximately ~40% of all individuals receiving a CT scan 3.
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