Surbhi Gupta, ms4 Radiology 6/2/17 Renal Cysts Surbhi Gupta, ms4 Radiology 6/2/17

Background TAF, 41 year old male History of IBS, now presenting as an outpatient with RUQ pain, diarrhea, weight loss

Initial Ddx and workup Differential diagnosis Workup Gallstones IBS flare IBD Pancreatitis Hepatitis Peptic ulcer disease Workup Vitals: stable, normal Physical exam: normal Labs: within normal CBC, CMP, viral panel RUQ u/s: hypoechoic right renal upper pole mass CT

2-5 images

Parameters and New ddx Lesion parameters New Differential Diagnosis Largest two lesions reaching 25mm Average Hounsfield units 30-45 No enhancement New Differential Diagnosis Renal cysts Neoplasm

Bosniak Classification Features Work-up Malignancy 1 Thin-walled, round None 0% 2 Few septae, fine calcifications, <3cm, non-enhancing 2F More septae, thick calcifications, >3cm, non-enhancing Follow with u/s or CT 5% 3 Thick and irregular septae, can be enhancing (+10-20 HU) Nephrectomy or radiofrequency ablation 55% 4 Solid with cystic or necrotic elements Nephrectomy 100%

Renal cysts overview Found in 50% of people over the age of 50 Unclear pathogenesis Complications Infection Ischemia Hemorrhage Pain Management Dx: ultrasound with Doppler, CT Tx: if symptomatic, ultrasound guided sclerotherapy vs laparoscopic cystectomy

Final diagnosis Bosniak class II cysts No intervention or follow up recommended Treatment with gut hypnotherapy and acupuncture for IBS

References Cecil G. Wood III, LeRoy J. Stromberg III, Carla B. Harmath, Jeanne M. Horowitz, Chun Feng, Nancy A. Hammond, David D. Casalino, Lori A. Goodhartz, Frank H. Miller, and Paul Nikolaidis. CT and MR Imaging for Evaluation of Cystic Renal Lesions and Diseases. RadioGraphics 2015 35:1, 125-141. Muglia, Valdair F., and Antonio Carlos Westphalen. “Bosniak Classification for Complex Renal Cysts: History and Critical Analysis.” Radiologia Brasileira 47.6 (2014): 368–373. PMC. Web. 1 June 2017. http://www.radiologyassistant.nl/en/p44d1045b472df/kidney-cystic-masses.html