Renal cyst - Bosniak class IV

Case contributed by Dr MT Niknejad

Presentation

Work up for right flank pain.

Patient Data

Age: 65 years
Gender: Male

A 130×110×115 mm cystic lesion with several eccentric enhancing solid components is present at the lower pole of the right kidney (Bosniak class IV). There are no signs of local invasion, surrounding fat stranding, vascular extension, or regional enlarged lymph nodes. 

A few small calcified foci are seen at liver parenchyma, most consistent with healed granuloma. 

A few adjacent small calcified foci are observed at the lower pole of the spleen. 

In imaged portions of the lower thorax, several subpleural nodules are seen at lung bases.

Case Discussion

The large majority of Bosniak IV masses are malignant and need surgical resection. 

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