Ultrasound
Oblique
Oblique
Oblique
Oblique
T0 image
Arterial phase cine
late phase
late phase
- The cystic lesion in the right kidney has inhomogenously increased echogencity. On noncontrast color Doppler and MV-flow artefactual twinkling can be observed within, which is likely due to inspissated calcific material. A thorough noncontrast evaluation before administering contrast is a must. It is also the time to decide whether the exam should be done with the patient breathing freely, or with breath holds. In this elderly patient the former option was selected, as the lesion could be kept in the FOV easily from a very lateral probe position.
- The T0 image is crucial (as with all CEUS exams) and it is prudent to document it, showing that in the CEUS preset there are no intrinsic artifacts present.
- A venous access could only be secured in the lower extremity, thus the amount of contrast agent given was increased by almost 100% (3 ml SonoVue).
- The cine loop shows the arterial phase, with the aforementioned freely breathing approach. The lesion in question shows no enhancement (also verified in the late phase), indicating that this is either a hemorrhagic or proteinaceaus complex cyst.