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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
Radiographic features , IVP:
Lucent defect
Cortical bulge
"Beak sign" can be seen with large cysts.
Radiographic features , US:
Anechoic
Enhanced through-transmission
Sharply marginated,smooth walls
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
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
Hydronephrosis:
Calyceal Diverticulum
Parapelvic Cyst
Renal Artery Aneurysm
Complicated CYSTS
Complicated cysts are cysts that do not meet the criteria of simple cysts and thus require further workup.
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
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.
Simple renal cyst, Bosniak Category I.
Bosniak Category II cyst
Curvilinear calcification within a thin septum
Bosniak Category II cyst
Homogeneously hyperdense mass No increase in Density after IV contrast
Bosniak Category II cyst
Cyst with several internal septations and a minimally thickened wall
Bosniak Category II cyst.
Cyst with uniform, mild wall thickening and short, interrupted calcifications
Bosniak Category II hyperdense cyst.
Bosniak Category II cyst
Bosniak Category II cyst.
Nearly completely calcified mass with no obviousenhancing elements
Bosniak Category II.
subcentimeter rim calcified renal cyst
Bosniak Category III.
cystic mass with irregular wall thickening andassociated heterogeneous nonenhancing elements
Bosniak Category III complex cyst.
multilocular, encapsulated mass
Bosniak Category III complex cyst.
Thick-walled, encapsulated, multilocular cystic mass with enhancing septa
Bosniak Category IV cystic neoplasm.
Bosniak Category IV cystic neoplasm
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
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