Diagnostic Ultrasound - Abdomen and Pelvis
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Diagnostic Ultrasound - Abdomen and Pelvis

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09.07.2019 Views

Cystic Disease of Dialysis (Left) Longitudinal ultrasound shows multiple cortical cysts st within an echogenic kidney in a patient with ESRD. Scattered parenchymal calcifications are visible. Although the kidney is atrophic, the apparent renal size is increased secondary to the numerous cysts. (Right) Coronal CECT scan in the same patient demonstrates the bilateral nature of ACKD, with typical numerous small cysts throughout both kidneys. Diagnoses: Urinary Tract (Left) Longitudinal ultrasound shows a markedly echogenic kidney consistent with ESRD. While 3 cysts are identified st, many subcentimeter cysts are not clearly visible with ultrasound. (Right) Coronal delayed-phase CT image in the same patient better depicts the numerous tiny cysts st, which were not clearly visible with ultrasound. (Left) Ultrasound can be limited in evaluating small lesions. Multiple small cysts are present in this patient with ESRD, but not clearly identified with ultrasound. In particular, there is a small peripheral solid lesion that even in retrospect is not well identified ſt. (Right) Axial T1W contrast-enhanced MR image in the same patient more clearly shows the enhancing mass ſt consistent with RCC. An additional smaller cortical cyst st was not clearly visible on the ultrasound. 473

Multilocular Cystic Nephroma Diagnoses: Urinary Tract TERMINOLOGY • Rare nonhereditary benign cystic renal neoplasm containing epithelial and stromal components IMAGING • Encapsulated multilocular cystic renal mass herniating into renal hilum • Grayscale ultrasound ○ Numerous anechoic cysts with hyperechoic septa ○ Occasionally more solid-appearing due to numerous tiny cysts causing acoustic interfaces • Fine vessels may be seen within septa on color Doppler • Contrast uptake within septa and wall on CEUS • CT: Large, well-defined multiloculated cystic mass, ± calcification, ± capsular enhancement • T1WI: Multiloculated hypointense mass (clear fluid) with variable signal intensity (blood or protein) KEY FACTS TOP DIFFERENTIAL DIAGNOSES • Cystic renal cell carcinoma (RCC) • Mixed epithelial and stromal tumor (MEST) • Cystic Wilms tumor CLINICAL ISSUES • Present with hematuria, abdominal/flank pain, palpable mass • Complications ○ Obstructive uropathy, infection, hemorrhage • Cured with complete surgical excisionblane • Bimodal age and sex distribution: 2-4 years old, M>F; 40-60 years old, F>>M DIAGNOSTIC CHECKLIST • Appears as Bosniak class 3 or 4 cystic mass • May be indistinguishable from cystic renal carcinoma • Presence of enclosing capsule distinguishes MLCN from almost all other cystic renal masses (Left) Longitudinal view of the right kidney reveals numerous small anechoic cystic locules ſt in the lower pole, separated by echogenic septa, comprising a MLCN. This herniates into the renal hilum st, with associated obstruction of the renal pelvis leading to upper pole calyectasis . (Right) Coronal T2-weighted MR in the same patient demonstrates multiple hyperintense cystic locules ſt surrounded by a well-defined hypointense fibrous capsule . (Left) Longitudinal ultrasound view of the left kidney reveals multiple large anechoic cysts in the lower pole ſt separated by thick septae , consistent with MLCN. The upper pole cystic structure represents calyceal dilatation secondary to mass effect from the MLCN. (Right) Coronal contrastenhanced CT image in the same patient showing multiple large cystic locules ſt in the lower pole, surrounded by a thick fibrous capsule . Mass effect leads to calyceal dilatation in the upper pole . 474

Cystic Disease of Dialysis<br />

(Left) Longitudinal ultrasound<br />

shows multiple cortical cysts<br />

st within an echogenic kidney<br />

in a patient with ESRD.<br />

Scattered parenchymal<br />

calcifications are visible.<br />

Although the kidney is<br />

atrophic, the apparent renal<br />

size is increased secondary to<br />

the numerous cysts. (Right)<br />

Coronal CECT scan in the same<br />

patient demonstrates the<br />

bilateral nature of ACKD, with<br />

typical numerous small cysts<br />

throughout both kidneys.<br />

Diagnoses: Urinary Tract<br />

(Left) Longitudinal ultrasound<br />

shows a markedly echogenic<br />

kidney consistent with ESRD.<br />

While 3 cysts are identified st,<br />

many subcentimeter cysts are<br />

not clearly visible with<br />

ultrasound. (Right) Coronal<br />

delayed-phase CT image in the<br />

same patient better depicts<br />

the numerous tiny cysts st,<br />

which were not clearly visible<br />

with ultrasound.<br />

(Left) <strong>Ultrasound</strong> can be<br />

limited in evaluating small<br />

lesions. Multiple small cysts<br />

are present in this patient with<br />

ESRD, but not clearly<br />

identified with ultrasound. In<br />

particular, there is a small<br />

peripheral solid lesion that<br />

even in retrospect is not well<br />

identified ſt. (Right) Axial<br />

T1W contrast-enhanced MR<br />

image in the same patient<br />

more clearly shows the<br />

enhancing mass ſt consistent<br />

with RCC. An additional<br />

smaller cortical cyst st was<br />

not clearly visible on the<br />

ultrasound.<br />

473

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