Amorphous Bosniak 1 renal cyst (CEUS)

Case contributed by Dr Balint Botz

Presentation

Known chronic kidney disease with multiple simple cyst. Irregular cyst noted in the left kidney on B-mode US.

Patient Data

Age: 80 years
Gender: Male
Ultrasound
  • On B-mode US the cyst in question has an amorphous shape and has discrete wall irregularity, however it is almost completely anechoic. No flow signal using microvascular flow imaging
  • No artifacts on the T0 image. 
  • The cyst does not show enhancement in the arterial phase, and remains signal-free throughout the portal venous and late phase. Findings altogether are in line with an amorphous but simple, Bosniak 1 renal cyst.
  • Surveying the liver during the late phase shows small cysts appearing as signal voids on the CEUS image. 

Case Discussion

CEUS is an excellent method to reassuringly characterize amorphous-looking cysts detected by other imaging (noncontrast US in particular) techniques. It is also prudent to perform a survey of the liver in the late phase, since incidental but clinically significant lesions can be picked up this way. 

Note: as of 2021 renal CEUS is considered an off-label use in most countries. 

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