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Localized Cystic Disease of the Kidney

¹ Both authors: Department of Radiology, New York University Medical Center, Tisch HW 202, 560 First Ave., New York, NY 10016.

View larger version (124K): [in a new window]   Fig. 1A. —46-year-old man who presented with microscopic hematuria and lower urinary tract symptoms attributed to prostatitis. IV contrast-enhanced axial CT scan at level of middle portion of right kidney shows involvement by localized cystic disease. Note symmetric excretion of contrast medium.

View larger version (109K): [in a new window]   Fig. 1B. —46-year-old man who presented with microscopic hematuria and lower urinary tract symptoms attributed to prostatitis. CT scan slightly inferior to A shows multiple simple cysts separated by attenuated renal tissue (arrow).

View larger version (106K): [in a new window]   Fig. 1C. —46-year-old man who presented with microscopic hematuria and lower urinary tract symptoms attributed to prostatitis. CT scan inferior to B has more masslike appearance.

View larger version (125K): [in a new window]   Fig. 1D. —46-year-old man who presented with microscopic hematuria and lower urinary tract symptoms attributed to prostatitis. CT scan of lower pole inferior to C that, if viewed in isolation, could be confused with cystic neoplasm with enhancing septations. Arrow denotes attenuated renal tissue. CT at 8-year follow-up examination (not shown) showed no change in appearance or size of cysts. (Courtesy of Gold New York, NY)

View larger version (132K): [in a new window]   Fig. 2A. —67-year-old man who was incidentially found to have left renal abnormality diagnosed as localized cystic disease of kidney. CT scan obtained in 1992 shows normally enhancing renal tissue (arrow) separated by simple cysts.

View larger version (117K): [in a new window]   Fig. 2B. —67-year-old man who was incidentally found to have left renal abnormality diagnosed as localized cystic disease of kidney. CT scan corresponding to A obtained 6 years later shows radiographic stability. Uninvolved right kidney remained normal.

View larger version (149K): [in a new window]   Fig. 2C. —67-year-old man who was incidentally found to have left renal abnormality diagnosed as localized cystic disease of kidney. Unenhanced axial CT scan of lower pole of left kidney shows scattered calcifications in cyst walls (solid arrows). Regions of interest (circled) measure 1-10 H. Note incidental small duodenal lipoma (open arrow).

View larger version (123K): [in a new window]   Fig. 2D. —67-year-old man who was incidentally found to have left renal abnormality diagnosed as localized cystic disease of kidney. IV contrast-enhanced axial CT scan corresponding to C shows no enhancement in corresponding regions of interest (circled), which continue to measure 1-10 H. Note enhancing attenuated renal tissue. Calcification in the cyst walls was not a prominent feature and was seen in only four cases. (Courtesy of Shah H, Little Rock, AR)

View larger version (147K): [in a new window]   Fig. 3A. —50-year-old man admitted for evaluation of syncopal episodes and occasional right-sided flank pain. IV contrast-enhanced axial CT scan shows characteristic findings of localized cystic disease.

View larger version (100K): [in a new window]   Fig. 3B. —50-year-old man admitted for evaluation of syncopal episodes and occasional right-sided flank pain. T2-weighted half-Fourier acquistion single-shot turbo spin-echo (HASTE) axial image corresponding to A shows multiple cysts in right kidney.

View larger version (137K): [in a new window]   Fig. 3C. —50-year-old man admitted for evaluation of syncopal episodes and occasional right-sided flank pain. T2-weighted HASTE coronal image shows involvement of entire kidney by localized cystic disease and single small cyst in left kidney.

View larger version (135K): [in a new window]   Fig. 3D. —50-year-old man admitted for evaluation of syncopal episodes and occasional right-sided flank pain. MR arteriogram shows slightly attenuated right main renal artery (arrow) with splaying of intrarenal vessels around multiple cysts. Although entire kidney is involved with cysts, there is enough remaining functioning parenchyma so that excretion of contrast medium is present (images not shown).

View larger version (99K): [in a new window]   Fig. 4. —62-year-old man who was incidentally found to have cystic abnormality of right kidney. CT findings were interpreted as possible cystic neoplasm and patient underwent right nephrectomy. Pathologic evaluation showed findings of localized cystic disease. Although interpreted as possible cystic neoplasm, CT scan viewed with adjacent sections is characteristic of localized cystic disease of kidney with multiple simple cysts separated by attenuated enhancing renal tissue (arrow).

View larger version (114K): [in a new window]   Fig. 5. —Ct scan of pathologically proven multilocular cystic renal adenocarcinoma in 59-year-old man shows well-encapsulated mass in middle portion of left kidney with multiple enhancing septae (solid arrow). Mass of cystic locules is encompassed in single large encapsulated mass (open arrow). Enhancing tissue seen in lesion represents tumor tissue.

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