2012年11月30日星期五

What are the Tests and Examinations of Kidney Cysts



Kidney cyst is the general term kidney cystic mass ranging in size. It is not connected with the outsides the common renal cysts can be divided into adult polycystic kidney disease, simple renal cysts and acquired renal cysts.
Suggestion:
Laboratory tests
Urinalysis showed mostly normal. Microscopic hematuria is rare. Renal function tests are normal, unless the cyst as multiple or bilateral (rare) even if one side of the kidney surface extensive destruction of the contralateral kidney may also be due to the compensatory hypertrophy while maintaining the total renal function normal.
X-ray examination
Can be seen in the abdominal plain film often part of the kidney shadow enlargement or mass oppression. Cyst weight or position can cause the kidneys to reverse the abnormal renal axis. Sometimes striped calcification can be seen in the tumor edge. Excretory urography angiography can be diagnosed. 1 to 2 minutes after the intravenous injection of a contrast agent to radiography, visible renal vascular density increased, the cyst occupied part of the space that is not, because no blood vessels. urography continuous radiography shows mass presence of cysts around one or renal calyx or pelvis often become dented or bent, widened, flattened or lumen disappeared. oblique or lateral radiographs are also helpful in the diagnosis when the mass occupy lower pole of kidney, ureter segment will shift to the spine. kidney itself will rotate through the radiopaque sac or to see the psoas muscle. conventional urography can not effectively distinguish opaque renal parenchyma when renal tomographic X-ray photography to increase vascular renal parenchymal cysts contrast. occasionally renal tumors also relatively free of blood vessels, which is easy to be confused with the cyst. rare cases, the cyst wall tumors may also occur, Therefore, it is necessary for further identification of the diagnostic check.
CT scan
Identify renal cysts and tumors, CT is the most accurate. Cyst fluid density similar to water, and the density of the tumor and normal renal parenchyma similar after intravenous contrast agents, the renal parenchyma becomes more dense, and the cyst remains unaffected ; clear boundaries of the cyst wall and the renal parenchyma, tumor no; cyst wall is thin, but not with tumor. many ways, the identification of cysts and tumors CT is superior puncture fluid judgment.
Renal ultrasound
Ultrasound to take a non-invasive diagnostic techniques to identify renal cysts and substance of mass, a large proportion of ultrasound examination and found to comply with the image of the cyst ultrasound image monitoring can puncture the cyst and suction capsule fluid.
Isotope scan
Straight line scan shows the mass outline, but it is difficult to distinguish between a cyst or tumor. Technetium scan photography avascular mass.
In the cyst photography percutaneous cyst aspiration
When the above checks on the identification of cysts and tumors still have questions, necessary rows aspiration.
Differential Diagnosis
Basic checks
Urine check normal urine bag oppression renal parenchyma or merge sac infection, there may be a small amount of red blood cells and white blood cells in the urine.
B ultra understand the cyst number, size, wall. Renal mass can be differentiated as the preferred method of examination. Typical B-performance anechoic lesion, wall smooth, clear boundary how when imaging prompted; When the wall irregular echo should be alert to the malignant transformation; limitations echogenic wall thickening secondary infection, lesion fine echo intracystic echogenic bleeding. cysts with multilocular cysts, polycystic kidney distinguished.
Intravenous pyelogram (ivp) can show the extent of the cyst oppression renal parenchyma can identify hydronephrosis phase.
Further examination
CT B-ultrasound can not determine who rendered valuable cyst with bleeding infection malignant not homogeneous CT value increased when CT shows cyst characteristics do not have to be a cyst puncture
(1) Kidney cancer: was occupying lesions, but prone to deep, causing more obvious calyceal bending. Hematuria is common, while the cyst is not seen when the renal tumor pressure above the psoas muscle, abdominal plain chip to see less than the edge of the muscle, and the cyst is still visible. transfer evidence (such as weight loss, fatigue, touched supraclavicular lymph node enlargement, chest X-ray shows metastatic nodules), polycythemia, high calcium hyperlipidemia and accelerated ESR prompt cancer. remember the cyst wall can also occur cancerous change. renal vein cancer clogging, unclear or even not developing excretory urography. ultrasound image and CT is always the last to do differential diagnosis. angiography and renal tomography X-ray photography is rich in blood vessels in the tumor, a contrast agent-intensive "pond" cyst density unaffected. prove other diseases before, assume that the space-occupying lesions of all kidney cancer is wise.
(2) polycystic kidney disease: As shown in urography, the disease is almost always bilateral diffuse renal calyx and pelvis distorted its law has become a simple renal cysts isolated solitary. polycystic kidney disease is often associated with renal dysfunction and hypertension, renal cysts.
(3) renal carbuncle: the disease is rare. Acquisition history, history of skin infections in the weeks prior to the projection of fever and local pain urography showed similar lesions, cysts and tumors, but because of renal inflammation around the impact the renal contour waist muscles shadow blurred., kidney more than fixed. patients in the supine and upright kidney position to compare can be confirmed. angiography may be a non-vascular lesions. Gallium scan can display the inflammatory nature of the lesions, but simple renal cyst infection may also have similar performance.
(4) hydronephrosis: signs and symptoms may be entirely consistent performance with simple renal cysts, urography distinct. Cysts cause kidney deformation, while hydronephrosis will not.

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