This document discusses ultrasound findings of renal cysts and cystic renal lesions. It provides details on:
1) The Bosniak classification system used to characterize renal cysts and cystic masses as benign (Classes I and II) or malignant (Classes III and IV).
2) Characteristics of simple renal cysts, complex cysts, cystic renal cell carcinomas, and other cystic lesions.
3) Cystic manifestations of conditions like polycystic kidney disease, von Hippel-Lindau disease, and tuberous sclerosis.
Urinary system – common pathological correlationKochi Chia
Presentation on common urinary system pathologies and radiological findings. Just a brief explanation. Further info can be obtained from www.radiopaedia.org and www.radiologyassistant.nl
Description of various ultrasound features of benign and suspicious thyroid nodules with multiple ultrasound systems for risk stratification of malignancy.
Description of different ultrasound features of carpal tunnel syndrome before and after carpal tunnel release including Doppler imaging and elastography
Doppler ultrasound of visceral arteriesSamir Haffar
Doppler ultrasound of different diseases of visceral arteries including arterial stenosis and occlusion, arterial aneurysm, artrial pseudoaneurysm, arterio-venous fistula, artrial dissection, and abdominal vascular compression syndromes
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Ultrasound of the urinary tract
Renal cysts
Samir Haffar M.D.
Department of Internal Medicine
2. Ultrasound of renal cysts
• Common in population > 50 years (at least 50%)
• Scanning technique is important
Multiple positions: supine, LD, oblique, prone
Scan with appropriate focal zone
• Better demonstrated with THI: reduced background noise
• Main goal: differentiate surgical from nonsurgical lesion
Bosniak classification: based on CT scan
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
3. Bosniak classification
Used worldwide in evaluating cystic renal masses
• Originally described in 1986 & updated later
• Not a pathologic but imaging & clinical management system
• Developed on CT findings but applied to other modalities
US Cannot alone accurately characterized cystic mass
Except if renal mass is cystic (CT pseudoenhancement)
MRI Often used when CECT contraindicated
Higher Bosniak category than CT in some cases
Israel GM & Bosniak M. Radiology 2005 ; 236 : 441 – 450.
4. Bosniak classification of renal cysts
Category CT features Significance
Class I Water density homogenous
Noncalcified, smooth margin
No enhancing component
Benign
Chapple CR et al. Practical urology: Essential principles & practice.
Springer-Verlag, London , 2011.
Class II Thin septae (<1 mm)
Thin calcification (<1 mm)
Hemorrhagic cyst
Benign
Class IIF Likely benign
Follow-up imaging indicated
Class III Thick septa
Thick calcification
Thick wall
Multilocular +/− enhancement
≈ 50% malignant
Class IV Criteria of category III
Enhancing solid mass of wall or septa
Definitely malignant
5. Simple cortical cyst
Bosniak category I cyst
Bosniak MA. Radiology 1986 ; 158 : 1 – 10.
Paspulati RM et al. Ultrasound Clin 2006 ; 1 : 25 – 41.
Three characteristics
- Anechoic
- Sharply defined smooth wall
- Posterior acoustic enhancement
If all these sonographic criteria are met
Further evaluation or follow-up is not required
6. Tissue harmonic imaging (THI)
Probable cyst on right kidney
Evident internal echoes
Gray-scale US
THI “cleaned-up” image
Removing internal echoes
Simple renal cyst
Application of THI
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
7. Better lateral & axial resolution
Enhanced signal-to-noise ratio
Reduced artifacts
Theoretic advantages of THI
Less degradation of sonographic images
8. Milk of calcium renal cyst
Renal cyst with dependent echogenic material
Mobile on real-time examination
This kind of cyst is always benign
Rumack CM et al. Diagnostic Ultrasound. Elsevier-Mosby, St. Louis, USA, 3rd edition, 2005.
9. Complex renal cyst
Do not meet strict US criteria of simple renal cyst
• 5-10% of all renal cysts are not simple cysts
• 5-10 % of complex renal cysts prove to be tumors
• Complex cysts: Wall thickening
Septations & nodularity
Calcification
High attenuation (>20 HU at CT )
Signal not typical of water at MRI
Enhancement
• 2 main causes Complicated simple cyst, cystic RCC
Hartman DS et al. RadioGraphics 2004 ; 24 : S101 – S115.
10. Paspulati RM et al. Ultrasound Clin 2006 ; 1 : 25 – 41.
Minimally complicated renal cyst
Bosniak category II cyst
Renal cyst with thin septation
Artifact from septation
Frequently seen at real-time US
11. Cyst with mural nodule Complex cystic renal lesion
Thick nodular septations
Rumack CM et al. Diagnostic Ultrasound. Elsevier-Mosby, St. Louis, USA, 3rd edition, 2005.
Complicated renal cyst
Bosniak category III cyst
12. Cystic growth patterns of renal cell carcinoma
Yamashita Y et al. Acta Radiologica 1994 ; 35 : 19 – 24.
Rumack CM et al. Diagnostic Ultrasound. Elsevier-Mosby, St. Louis, USA, 3rd edition, 2005.
Multilocular
Unilocular
Cystic necrosis
Origin in wall of
simple cyst
13. CECT
Enhancing soft-tissue
components within cyst
Cystic RCC
Adilson P et al. RadioGraphics 2006 ; 26 : 233 – 244.
Cystic mass with several
solid nodular components
US of right kidney
Complicated renal cyst
Bosniak category IV cyst
14. Multilocular cystic nephroma (MLCN)
Benign nonhereditary cystic neoplasm
• Multiple epithelially lined not communicating cysts
Benign neoplasm usually, metastases have been reported
• Bimodal presentation Males younger than 2 years
Women during 5th – 8th decades
• US:mass containing multiple cysts or internal septations
Not possible to distinguish from multiloculated RCC
Both are usually surgical lesions
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
15. Multilocular cystic nephroma (MLCN)
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
Predominantly cystic mass
Multiple internal septations
Longitudinal US
Better representation of lesion's
internal architecture at US
CECT scan
16. Multilocular cystic nephroma
Multiloculated RCC
Findings suggestive of MLCN
Absence of intratumoral or perinephric bleeding at CT or MRI
Herniation of portion of mass into renal pelvis
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
17. Renal sinus cyst
Common (1.5 % in autopsy series)
• Lymphatic in origin or develop from embryologic rests
• Do not communicate with collecting system
• Manifestations Most asymptomatic
Infection, bleeding, HTN, hydronephrosis
• Two patterns Parapelvic: single cyst in sinus & parenchyma
Peripelvic: multiple confluent cysts in sinus
The term renal sinus cyst recommended as generic
description of any fluid-filled cyst found in renal sinus
Rha SE et al. RadioGraphics 2004 ; 24 : S117 – S131.
18. Renal sinus cysts
Do not communicate with collecting system
Multiple renal sinus cysts
Mimic hydronephrosis
IVP, CECT, or MRI may be needed
Rumack CM et al. Diagnostic Ultrasound. Elsevier-Mosby, St. Louis, USA, 3rd edition, 2005.
Single renal sinus cyst
Simple cyst located in
renal sinus area
19. Ureteropelvic junction obstruction
Bilateral in one fourth of children
Severe UPJ obstruction
Dilated calyces as large cysts
Symmetrical in size
Communicate by sonography
Diminished renal parenchyma
UPJ obstruction
Dilatated intrarenal collecting system
Right ureter not dilated
Consistent with UPJ obstruction
Sivit CJ. Ultrasound Clin 2006 ; 1 : 67 – 75.
20. Cyst puncture
• Helpful in cases considered to be infected cyst or abscess
• Rarely use for management decision about cystic masses
Negative biopsy result does not rule out malignancy
Evaluation portion of lesion may result in misdiagnosis
• Complications: Tumor spread along needle track
Rupture
Bleeding
Infection
Hartman DS et al. RadioGraphics 2004; 24 : S101 – S115.
22. Autosomal dominant polycystic kidney disease
ADPKD
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
15.6 cm
Cysts of variable size with bilaterally enlarged kidneys
Compression of central sinus echo complex
Nephrolithiasis (20 – 35 % of patients)
Hepatic, pancreatic, ovarian, splenic, arachnoid, & other cysts
23. Differentiation simple cortical cysts from ADPKD
• Multiple cysts
At least 2 in each kidney after 30 years of age
CT shows multiple smaller cysts not visible on US
Distinction difficult in elderly: multiple cortical cysts
• Family history of ADPKD
• Coexistence of cysts in other organs
• Gene markers for ADPKD
McGahan J et al. Diagnostic ultrasound, Informa Healthcare, 2nd edition, 2008.
24. Screening of ADPKD
Renal US & DNA analysis in 319 patients at risk
Ravine D et all. Lancet 1994 ; 343 : 824 – 827.
Nicolau C et al. Radiology 1999 ; 213 : 273 – 276.
Person at risk & younger than 30 years
Two cysts in one kidney or one cyst in each kidney
Person at risk & aged 30 – 59 years
Two cysts in each kidney
Person at risk & aged 60 years or older
Four cysts in each kidney
Sen: 95% (ADPKD-1) – 65% (ADPKD-2)
(Sen: 100%)
(Sen: 100%)
26. Autosomal recessive polycystic kidney disease
ARPKD
• Varying degrees of renal failure & portal hypertension
• Severe form After birth – renal disease predominates
Neonatal US Kidneys enlarged bilaterally
Oligohydramnios
Potter’s facies
Pulmonary complications
• Later presentation Renal impairment & complications of CHF
Ultrasound Kidneys maintain reniform shape
Bilaterally enlarged & echogenic
27. ARPKD
Right kidney
10 cm in length
Bilaterally enlarged echogenic kidneys in a newborn
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
Left kidney
9.8 cm in length
28. von Hippel-Lindau disease
Rare disease (prevalence 1/ 35.000 – 40.000)
• Autosomal dominant disease with high penetrance
• Development of variety of benign & malignant tumors
• Broad clinical manifestations: 40 lesions in 14 organs
• Diagnostic criteria
More than one CNS hemangioblastoma
One CNS hemangioblastoma & visceral manifestations
Any manifestation & familial history of VHL disease
32. Leung RS et al.. RadioGraphics 2008 ; 28 : 65 – 79.
Multiple lesions of mixed echotexture
Multiple RCCs
von Hippel-Lindau disease (VHL)
Renal cell carcinoma (25 – 45%)
Sagittal US of left kidney CECT scan
Simple cysts
Solid enhancing lesions
Right nephrectomy (RCCs)
CBD stent (pancreatic cysts)
33. Leung RS et al.. RadioGraphics 2008 ; 28 : 65 – 79.
Multiple lesions of mixed echotexture
Multiple RCCs
von Hippel-Lindau disease (VHL)
Renal cell carcinoma (25 – 45%)
Sagittal US of left kidney CECT scan
Simple cysts
Solid enhancing lesions
Right nephrectomy (RCCs)
CBD stent (pancreatic cysts)
34. Screening protocol for VHL disease
Body System Regimen Follow-up
Renal Annual abdominal US from 10 y CT or MR
Depending on US findings
CNS MRI of brain & spine at 20 y
Annual neurologic exam if symptoms
Repeat imaging if suspicion
Adrenal Annual 24-h urinary VMA from 10 y
Annual blood pressure measurement
Imaging if VMA abnormal
Ophthalmic Annual ophthalmoscopy from 5 y
With or without fluorescein
–
Auditory Questionnaire
Audiogram if questionnaire positive
MRI If audiogram abnormal
Leung RS et al.. RadioGraphics 2008 ; 28 : 65 – 79.
38. Renal cysts seen in cortex & medulla
Appear at an earlier age than cysts seen in APKD
Tuberous sclerosis / Multiple renal cysts
Weber TM. Ultrasound Clin 2006 ; 1 : 15 – 24.
Not primary diagnostic feature
39. Angiomyolipoma – Classic pattern
Paspulati RM et al. Ultrasound Clin 2006 ; 1 : 25 – 41.
CT (excretory phase)
Fat attenuation lesion
Household unit of – 8
Well defined hyperechoic mass
Posterior acoustic shadowing
Longitudinal US of right kidney
Intratumoral fat on CT almost confirms diagnosis of AML
40. Renal intratumoral fat attenuation
Logue LG et al. RadioGraphics 2003; 23:241–246
Almost pathognomonic for AML
Rare benign & malignant tumors considered
• Renal cell carcinoma
• Lipoma & liposarcoma
• Myolipoma
• Oncocytoma
• Wilms tumor
41. Acquired cystic disease
Bates J A. Abdominal Ultrasound: How, Why and When.
Churchill Livingstone, Edinburg, UK, 2nd edition, 2004
Patients on long-term dialysis (shrunken end-stage kidneys)
Frequency increases with duration of dialysis
Potential for malignancy: screen native kidneys even after RT
42. Multicystic Dysplastic Kidney (MCDK)
• Complete early ureteral obstruction (< 8th – 10th week)
Incomplete ureteral obstruction later (10th – 36th week)
• Contralateral renal anomalies:
Most commonly UPJ obstruction in 33% of patients
• US Large non communicating cysts
Absence of identifiable cortical parenchyma
Absence of central sinus structures
• Calcify or not identifiable in few patients on follow-up
43. Multicystic dysplastic kidney (MCDK)
Renal dysplasia
Longitudinal view Transverse view
Sivit CJ. Ultrasound Clin 2006 ; 1 : 67 – 75.
Multiple parenchymal cysts of varying size
Cysts do not communicate
Absence of identifiable cortical parenchyma
Absence of central sinus structures
They are extremely common, the frequency increasing with age. They occasionally reach a considerable size of more than 10 cm, although they are usually 4 cm or less.Although cortical, they may be peripheral, extend from the surface of the kidney, or lie centrally, originating in the columns of Bertin. They often are multiple, particularly in the elderly, and when they are numerous, it is difficult to distinguish multiple cortical cysts fromautosomal dominant polycystic kidney disease (ADPKD).
Radiologic features that favor renal cell carcinomaPresence of blood in the tumor or in the perinephric space at CT or MR imagingRelatively large solid areas within the tumor mass, intravascular extension, or distant metastases. Findings suggestive of multilocular cystic nephromaAbsence of intratumoral or perinephric hemorrhageHerniation of a portion of the mass into the renal pelvis.
Also known as peripelvic cysts, parapelvic lymphatic cysts, parapelviclymphangiectasia, and parapelvic cyst.RSCs are likely lymphatic in origin or develop from embryologic rests.These cysts do not communicate with the collecting system.Most RSCs are asymptomatic, but they may become infected or bleed, and may cause hematuria, hypertension, or hydronephrosis
Multiple underlying factors have been proposed including:1- Abnormal development of the proximal ureteral smooth muscle2- Aberrant vessels, or bands crossing the upper ureter and renal pelvis3- Delayed recanalization of the fetal ureter4- Abnormal ureteral peristalsis.The ipsilateralureter is typically not dilated in children who have a UPJ obstruction, although ureteralvesical junction (UVJ) may occasionally coexist and result in a dilated ureter.
Parfrey PS et al. N Engl J Med 1990 ; 323 : 1085 – 90.US, because of high sensitivity and low cost, has become the primary method of diagnosing ADPKD and following the cysts.US screening for ADPKD typically begins between ages 10 & 15 years, (false negatives in 14% of patients younger than 30 years). Bear and colleagues developed criteria that are widely used to diagnose ADPKD. In adults who have a family history of ADPKD, the presence of at least three cysts in both kidneys, with at least one cyst in each kidney, is a positive finding.
Renal US & DNA analysis for ADPKD were performed in 319 patients who were at risk. PKD1: short arm of chromosome 16 – Account for 85 – 90 % of population with ADPKD.PKD2: Long arm of chromosome 4 – Account for 10 – 15% of population with ADPKD.In some other families, no linkage to either PKD1 or PKD2 has been reported.
No increased risk for RCC in patients who have ADPKD, except for: 1- Increased risk related to dialysis2- Generally increased risk for RCC in men
If TS is a consideration, the diagnosis can usually be confirmed on CNS imaging with subependymalhamartomasor giant cell astrocytomas.Multiple renal AMLs are a primary diagnostic feature of TS.Renal cysts are not the primary diagnostic feature of TS.
Tuberous sclerosis (Bourneville disease) is a phacomatosis, classically described as the triad of adenoma sebaceum, seizures, and mental retardation. The inheritance is autosomal dominant.
If TS is a consideration, the diagnosis can usually be confirmed on CNS imaging with subependymalhamartomas or giant cell astrocytomas. Presence of subependymal nodules and giant cell astrocytoma are sine qua non of TS.
Small RCCs can be hyperechoic and indistinguishable from an AML on sonography. Hypoechoic rim and intratumoral cystic changes are seen only in RCC, whereas acoustic shadowing is observed with AML.Rarely, RCCs can demonstrate fat attenuation caused by entrapment of the perinal or renal sinus fat, lipid necrosis, or osseous metaplasia. The characteristic intratumoral fat cannot be detected in 4.5% of AMLs. This finding has been attributed to minimal fat content or immature fat. These AMLs with low fat content demonstrate homogeneous and prolonged enhancement on a contrast enhanced scan, which distinguishes them from an RCC.
perirenal fat entrapment, lipid necrosis, or osseous metaplasia, all of which may occur in renal cell carcinoma