Hyperdense Cyst?

[bonie__0__0]

  After recent blood work, it was discovered by my endocrinologist that I had five times the normal amount of aldostrone and renin in my bloodstream. After having ruled out renal artery stenosis vvia a renal scan, he advised that it probably was a renin producing tumor. I just had a CT scan which showed the following: one 1.5x1.5 cm. "nodule" on the lower pole of the L kidney and a 1cm. "hyperdense" lesion also on the lower pole. By the wqy, I had fatty infiltration of the L lobe of the liver, don't know if this has anything to do with the other stuff. My question is, what is a "hyperdense" lesion, and is it usually malignant? Could the nodule also be cancerous.? What is the procedure if they are benign, as I experiance incidents of severe hypertension that is barely controlled with medication. I do have constant lower left back pain, but no hematuria as of yet. Are these guys producing the renin, and is that a sign of malignancy? Thank you for any response and info you might give me, as you might be able to discern, I'm quite worried, as my sister had breast cancer two years ago. Thanks again

[hfhs M.D.-AK]

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Dear Bonnie,
There are studies that can localize the amount of renin in each of the renal veins such that a side (right or left) can be determined.  It is important because when you are operating for a specific purpose or goal(hypertension), once the surgery is completed, you want to have accomplished that goal.  In this case it would be normal blood pressure.  It would also be important to examine the adrenal glands on the CT scan since aldosterone producing tumors or hyperplastic tissue that produces aldosterone in the adrenals are usually the source.
It is also important to make sure that the masses in the kidney have been sufficiently work-up.  Make sure the lesion you describe in the kidney doesn’t enhance with the contrast images on the CT scan.  There are characteristic images of cysts on CT scan.  If  a radiologist reads the film as a hyperdense cyst then you should have close follow-up of this lesion with interval CT scans.  If there is any question that this may be a cancerous process, then see a urologist immediately and get a second opinion..  The size and position of the kidney probably makes you a candidate for a partial nephrectomy but this would be up to your urologist.  A lesion of the kidney is nothing to take lightly particularly since this mass is dense.  I don’t have the advantage of viewing the scan therefore my input is limited.  I would recommend the films be reviewed by a radiologist or urologist who deal with CT scan of the abdomen all the time.
This information is provided for general medical educational purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.  More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653-6568).
Sincerely,
HFHS M.D.-AK
*keyword:Kidney Mass