Elderly Patient with Multiple Bilateral Renal Cortical Cysts

Multiple bilateral renal cortical cysts are a common finding in elderly patients. They are typically benign and do not cause any symptoms. However, in rare cases, they can become infected, bleed, or enlarge enough to cause pain or kidney dysfunction.

# Presentation:

The most common presentation of multiple bilateral renal cortical cysts is an incidental finding on imaging studies, such as an ultrasound or CT scan. Patients may also present with symptoms related to complications of the cysts, such as infection, bleeding, or pain.

Ultrasound imaging findings, as well as the Bosniak classification:

*Ultrasound imaging findings of multiple renal cysts:

    * Multiple, round, anechoic (fluid-filled) lesions in the kidneys.

    * The cysts are of different sizes.

    * The cysts have thin walls.

    * The cysts don't  have internal septations.

    * The cysts do not have calcifications.

* Bosniak classification for simple renal cortical cysts:

    * Bosniak I cysts are simple cysts with no internal echoes, septations, or calcifications. They are benign and do not require any further imaging or treatment.

    * Bosniak II cysts are complex cysts with thin septations or calcifications. They are benign in most cases, but may require further imaging or treatment if they are large or growing.

    * Bosniak III cysts are complex cysts with thick septations, irregular borders, or nodularity. They have a higher risk of being malignant and may require surgery.

    * Bosniak IV cysts are cystic masses with features of malignancy, such as solid components, thick septations, and irregular borders. They are almost always malignant and require surgery.

Bosniak grade of this patient: Bosniak 1:

In the case of the elderly patient with multiple bilateral renal cortical cysts, the ultrasound imaging findings are consistent with Bosniak I cysts. This means that the cysts are benign and do not require any further imaging or treatment. 

#Diagnosis:

The diagnosis of multiple bilateral renal cortical cysts is made with imaging studies. Ultrasound is a good initial test for detecting cysts in the kidneys. CT scan is more sensitive than ultrasound for detecting small cysts and can also be used to assess the size and number of cysts, as well as the amount of normal renal parenchyma that is preserved.

#Prognosis:

The prognosis for patients with multiple bilateral renal cortical cysts is generally good. The cysts are typically benign and do not cause any long-term problems. However, in rare cases, the cysts can become infected, bleed, or enlarge enough to cause kidney dysfunction.

#Management:

The management of multiple bilateral renal cortical cysts is generally conservative. Patients are typically monitored with regular imaging studies to assess the size and number of cysts. If the cysts become infected, they may need to be drained or treated with antibiotics. If the cysts bleed, they may need to be embolized or surgically removed. If the cysts enlarge enough to cause kidney dysfunction, they may need to be surgically removed.

Points to Remember:

* Multiple bilateral renal cortical cysts are a common finding in elderly patients.

* They are typically benign and do not cause any symptoms.

* In rare cases, they can become infected, bleed, or enlarge enough to cause pain or kidney dysfunction.

* The diagnosis is made with imaging studies.

* The prognosis is generally good.

* Management is typically conservative, with regular imaging studies and treatment of complications as needed.

For more info about renal ultrasound:

Ultrasound imaging of kidneys