Diagnostic Ultrasound - Abdomen and Pelvis

Cystic Disease of Dialysis
Diagnoses: Urinary Tract
TERMINOLOGY
• Presence of 3 or more renal cysts per kidney in patients
with chronic kidney disease (CKD) who do not have
hereditary cystic disease
• Occurs predominantly in patients on long-term dialysis
(peritoneal or hemodialysis)
• Can be seen in up to 13% of patients with CKD prior to
dialysis
IMAGING
• Ultrasound as initial investigation for establishing diagnosis
in patients on dialysis
• Multiple bilateral small cysts in normal-sized or atrophic,
echogenic kidneys
○ Simple cysts:Well-defined round lesions with posterior
acoustic enhancement, distinct echogenic posterior wall,
lack of internal echoes
○ Hemorrhagic cysts: May contain visible internal echoes or
debris
KEY FACTS
○ Malignant transformation of cysts typically manifests as
papillary growth within the cyst
• Cysts scattered in both renal cortex and medulla
• Renal size may be enlarged due to increase in size and
number of cysts
• Contrast enhanced ultrasound (CEUS), CECT, or CEMR are
required to evaluate complex cysts and distinguish from
renal cell carcinoma (RCC)
TOP DIFFERENTIAL DIAGNOSES
• Multiple simple cysts
• Adult polycystic kidneys disease (ADPKD)
• von Hippel-Lindau disease
• Tuberous sclerosis (TS)
• Medullary cystic disease
CLINICAL ISSUES
• Renal cell carcinoma occurs in up to 7% of patients with
acquired cystic kidney disease (ACKD)
(Left) US shows a markedly
echogenic kidney with
multiple small cortical and
medullary cysts st. Many of
these contain peripheral
calcifications , more
common in ACKD than in agerelated
simple renal cysts. One
of these is entirely calcified
. (Right) Longitudinal US
shows the lateral aspect of the
left kidney in a patient
with ACKD. A large exophytic
complex cyst ſt with internal
echoes is suspicious for
malignancy, despite the lack
of color flow. Surgical
pathology confirmed a
papillary renal cell carcinoma.
(Left) Longitudinal color
Doppler image shows multiple
cysts ſt within an echogenic
kidney . The inferior cyst
has internal echoes and
lack of color flow, consistent
with a hemorrhagic cyst,
common in patients with
ACKD. (Right) Coronal CT
image in the same patient
shows the corresponding
hyperdense ſt cyst in the mid
to lower pole. There was no
evidence of enhancement on
this multiphase CT scan, which
is consistent with a
hemorrhagic cyst.
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