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renal calculi, renal cysts, diagnostic rocedures
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renal calculi, renal cysts, diagnostic rocedures

Hi:
This is my brief medical history and a few questions.

Findings: Ultrasonographic evaluation of the kidneys reveals the right kidney to measure 10.2 cm. The left kidney measures 10.7 cm.

6/17/04: By Renal ultrasound: " Patient has small renal cysts.(No mention on the size or number of cysts.) These are benign and require no therapy or significant follow up. As part of her hematuria follow up protocol, however, renal ultrasounds will be obtained on a regular basis. These will also demonstrate any growth of the cysts or the development of a renal CA."  

4/22/05: Procedure Description: US XO KIDNEYS
READINGS: 5 X 7X 6 mm anechoic structure with increased through-transmission is seen at the lower pole of the right kidney consistent with a simple cyst.
IMPRESSION: 7 mm simple cyst at the lower pole of the right kidney otherwise normal renal ultrasound

6/20/07: Bilateral Renal Ultrasound:
Readings:
4 mm cortical calculus - at the right kidney
6 mm calculus - at the inferior pole of the right kidney

8 mm cyst - at the inferior pole of the right kidney

4 mm calculus - inferior pole of the left kidney
2 additional calculi - midpole of the left kidney measuring 5.5 and 5.8 mm

1.8 x 1.2 cm cyst - at the inferior pole of the left kidney

There is no evidence for  hydronephrosis of either kidney  

IMPRESSION: Bilateral renal cysts and nonobstructing renal calculi as above

6/11/08: CT ABDOMEN W/O CONTRAST
             CT PELVIS W/O CONTRAST
FINDINGS:
Tiny punctuate calcific density noted immediately anterior to the left distal ureter probably related to a vascular calcification (image 68). No definite nephrolithiasis or uretal calculi identified. No hydronephrosis.  
4 mm rounded hyperattenuating structure along the inferior pole of the right kidney consistent with a small hyperdense cyst. Kidneys appear to be unremarkable bilaterally.

IMPRESSION:
1. No evidence of nephrolithiasis.
2. Small right renal hyperdense cyst.
My Questions:
1. Is this hyperdense cyst something to be concerned about and need to be monitored?

2.My urologist needs a demonstration of any growth of the cysts or the development of a renal CA.
My cyst in 2004 was small. In 2005 the cyst has grown to 7mm. In 2007 the cyst has grown to 8mm. In 2008 (at the same location, perhaps?) the cyst decreased in size to 4mm but this one was classified as a hyperdense cyst. What is your take on this?    

3. Could this 4 mm rounded hyperdense cyst along the inferior pole of the right kidney used to be the 8 mm cyst observed at the inferior pole of the right kidney that was noted in 2007?  Do these cysts sometimes generally get smaller by itself overtime? Or could this be in addition to the 8 mm one and therefore might be spreading? Or the radiologist would have noted that this hyperdense cyst is in addition to the 8 mm one? Do I need to send for the previous years’ ultrasound films?

4. Since there was no comparison ( the previous ultrasounds were done out of state) if a follow up is recommended, should it be done in 6 months?      

5. To rule out kidney stones which diagnostic procedure is better, renal ultrasound or ct abdomen w/o contrast/ct pelvis w/o contrast? Or are they all the same -  renal ultrasounds with different names?

6. Is it possible that the ct abdomen and ct pelvis w/o contrast, if different from renal ultrasound, is not powerful enough so as to miss all the renal calculi seen through Bilateral Renal Ultrasound done on 6/20/07?
   - Or did all the renal calculi just got dissolved?

7/07: 24 hr. urine test: gamma globulins  - 1.7 (H)    Reference Range: 0.6 - 1.6 g/dL
INTERPRETATION: The increase in the gamma globulins appears to be polyclonal, suggesting a chronic inflammatory response.  

7. Does this have something to do with the chronic swelling or inflammation of my right foot?

Thank you very much.

Cevan
Related Discussions
Avatar_f_tn
Hello ceva,

Cysts develop from renal tubule segments and most detach from the parent tubule after they grow to a few millimeters in size. It seems that you have inflammatory symptoms for which you would require surgical exploration. Please take effective antibiotics in consultation with your urologist.

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