A complex cyst was found incidentally in an earlier ultrasound of the right kidney.

After confirming the complex nature of the cyst the role of CEUS will be to demonstrate any septal enhancement, or an otherwise occult peripheral soft tissue component, while we have to keep in mind that calcifications will likely cause artefacts during contrast enhanced imaging as well.

The actual CEUS - as always - is preceeded by a thorough re-evaluation of the lesion. Here the CEUS shows a typical CEUS appearance of a Bosniak IIF complex cyst. Cysts with septal enhancement - however minimal it may be - require regular follow-up. 

It is a good practice to document the lesion again after switching to the CEUS preset but before the injection of contrast (T:0), to register any intrinsic tissue artefacts present within.

NOTES:

- As of 2019 renal CEUS is considered an off-label use in most countries. 

- Due to the otherwise prohibitively large size of such imaging datasets the cine acquisitions had to be truncated, and downgraded (compression).