Presentation
Recurrent episodes of left flank pain in a patient with polycystic kidney disease. Not certain if due to hemorrhage into a cyst or mass effect of the cysts. Several cysts are hyperdense on CT ? blood
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
CT performed initially
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Typical findings of polycystic disease with enlarged cystic kidneys. Note multiple hyperdense cysts on the left including the antero-medial kidney (arrow), suspicious of hemorrhage.
MRI to assist in interpretation of CT findings
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Confirmed blood in antero-medial left kidney based on morphology and signal characteristics on T1 and T2 as well as lack of enhancement.
Case Discussion
It can be very difficult to determine if a hyperdense cyst in polycystic disease contains blood or proteinaceous fluid based on the CT findings. MRI is better able to differentiate the two. Blood in this case has a morphological pattern of a peripheral bright T1 (low signal T2) rim indicative of intracellular methemoglobin and large core of predominately T1 and T2 hypointensity indicative of deoxyhemoglobin. This is not typical of a uniform fluid-filled structure ie cyst. Note there are adjacent cysts containing clear fluid ie low T1 and high T2 signal and proteinaceous fluid ie high T1 and low T2.
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