Renal complex cyst (Bosniak category III)

Case contributed by Dr Mohammad Taghi Niknejad

Presentation

Work up for hematuria.

Patient Data

Age: 45 years
Gender: Female

Post-operative changes are seen due to partial nephrectomy at lower pole of right kidney. 
A 10 mm stone (450 HU) is present at lower calyx of right kidney.

A 35 mm high attenuation mass (35 HU) is present at right kidney which shows no obvious enhancement on post contrast images. 

Several stones less than 20 mm (1050 HU), are seen at lower pole of left kidney accompanied by focal hydrocalyces and causing adjacent parenchymal atrophic changes. 

Degenerative changes as osteophytosis are seen at the lumbar spine.

Post-operative changes are seen due to partial nephrectomy at lower pole of right kidney. 

There is a 35 mm thick-walled cystic exophytic lesion at lower pole of right kidney. After contrast injection, mild marginal enhancement is noted. There is no solid enhancing component. No vascular extension or adjacent organs invasion could be seen.

Several low signal stones are seen at lower pole of left kidney accompanied by focal hydrocalyces and causing adjacent parenchymal atrophic changes. 

Case Discussion

Right renal hyper dense cystic lesion compatible with Bosniak category III.

The Bosniak classification system of renal cystic masses divides renal cystic masses into five categories based on imaging characteristics on contrast-enhanced CT. It is helpful in predicting a risk of malignancy and suggesting either follow up or treatment.

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