1/ Hello #MedTwitter
This month’s @ASPNeph Imaging Webinar was about #cystickidneydisease
Here are some nuggets!
#Medtweetorial #nephtwitter #kidneycysts #ciliopathies
Let’s start with a poll!
Which of the following is true about kidney cysts?
This month’s @ASPNeph Imaging Webinar was about #cystickidneydisease
Here are some nuggets!
#Medtweetorial #nephtwitter #kidneycysts #ciliopathies
Let’s start with a poll!
Which of the following is true about kidney cysts?
2/ All the above
If cysts in children are rare, why do we care?!
Cysts can be-
🔸symptomatic (pain, infection, bleeding, obstruction)
🔹a marker of underlying disease (PKD)
🔸can be associated with progressive worsening of kidney function
🔹can have malignant potential
PMC6704226
If cysts in children are rare, why do we care?!
Cysts can be-
🔸symptomatic (pain, infection, bleeding, obstruction)
🔹a marker of underlying disease (PKD)
🔸can be associated with progressive worsening of kidney function
🔹can have malignant potential
PMC6704226
3/ Imaging:
🔸Ultrasonogram (USG) +/- doppler → best in children
🔹Contrast enhanced USG (fig)- delineates blood blow and microcirculation, differentiates solid vs cystic components, communication with subcapsular space if present etc
cureus.com
🔸Ultrasonogram (USG) +/- doppler → best in children
🔹Contrast enhanced USG (fig)- delineates blood blow and microcirculation, differentiates solid vs cystic components, communication with subcapsular space if present etc
cureus.com
4/
🔹CT & MRI→eval of complex cysts
Cons- sedation & contrast
🔸IVP/ Urography→connection to calyceal system
🔹Angiography- vascularization
🔸DMSA Scintigraphy- evaluate fn (multiple cysts)
🔹MR Urography: functional & comprehensive assessment, quicker
Cons:💰,availability
🔹CT & MRI→eval of complex cysts
Cons- sedation & contrast
🔸IVP/ Urography→connection to calyceal system
🔹Angiography- vascularization
🔸DMSA Scintigraphy- evaluate fn (multiple cysts)
🔹MR Urography: functional & comprehensive assessment, quicker
Cons:💰,availability
5/ DDx solitary cyst:
🔹Epithelial (Simple cortical) cyst
🔸Para & peri pelvic cyst
🔹Dilated minor/ major calyx- hydronephrosis or diverticulum
🔸Renal abscess
🔹Aneurysm/ Pseudoaneurysm- doppler differentiates
🔸Cystic Wilms in children
🔹Adults- Cystic/ papillary RCC, lymphoma
🔹Epithelial (Simple cortical) cyst
🔸Para & peri pelvic cyst
🔹Dilated minor/ major calyx- hydronephrosis or diverticulum
🔸Renal abscess
🔹Aneurysm/ Pseudoaneurysm- doppler differentiates
🔸Cystic Wilms in children
🔹Adults- Cystic/ papillary RCC, lymphoma
6/ Differential diagnosis for Multiple Cysts/ Ciliopathies:
🔸ADPKD
🔹ARPKD
🔸MCDK
🔹NPHP
🔸HNFβ1- asso. PKD
🔹Glomerulocystic disease
🔸TSC
Adults: above, and ADTKD, VHL, MSK, Glomerulocystic kidney disease, Dialysis asso. cysts, Lithium-related cysts, cystic nephroma, RCC, etc
🔸ADPKD
🔹ARPKD
🔸MCDK
🔹NPHP
🔸HNFβ1- asso. PKD
🔹Glomerulocystic disease
🔸TSC
Adults: above, and ADTKD, VHL, MSK, Glomerulocystic kidney disease, Dialysis asso. cysts, Lithium-related cysts, cystic nephroma, RCC, etc
7/ How to assess the malignant potential of cystic kidney lesions in children?
⚡️The modified Bosniak classification system⚡️
🔹Class 1 or 2- most often benign
Class 2- periodically monitored
🔸class 3 or 4- >90% has intermediate / malignant pathology -excision warranted
⚡️The modified Bosniak classification system⚡️
🔹Class 1 or 2- most often benign
Class 2- periodically monitored
🔸class 3 or 4- >90% has intermediate / malignant pathology -excision warranted
8/ Let’s pit MRI/ CT vs USG for classifying kidney cysts.
For Eg if you have Bosniak 2 category of cyst by USG-
For Eg if you have Bosniak 2 category of cyst by USG-
9/ B.
I was fascinated to know from @ASPNeph webinar that the sonogram is better at classifying the cyst. MRI/CT scan can downgrade the class but not upgrade. What is your experience?
Share it with us in the comments.
I was fascinated to know from @ASPNeph webinar that the sonogram is better at classifying the cyst. MRI/CT scan can downgrade the class but not upgrade. What is your experience?
Share it with us in the comments.
10/ That’s all folks!
Here’s a tweetorial on pathogenesis of cysts and ciliopathies...
Here’s a tweetorial on pathogenesis of cysts and ciliopathies...
11/ For a case-based clinical discussion with radiology expert login to @ASPNeph website, April webinar. Answer questions to get #MOC2credits #Membereducation #ASPNFOAMgroup
Until next time…
@RoshanPGeorgeMD @SwastiThinks @basalely @priti899
Until next time…
@RoshanPGeorgeMD @SwastiThinks @basalely @priti899
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