Diagnostic Considerations

Other problems to be considered include the following:

Angiomyolipomas
Cysts of the renal sinus (including peripelvic cysts, parapelvic cysts, parapelvic lymphatic cysts, and parapelvic lymphangiectasia)
Hemangioma
Multilocular cystic nephroma

Differential Diagnoses

Workup

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Media Gallery

Cut surface of a nephrectomy specimen from a patient with a multicystic dysplastic kidney (MCDK).
Nephrectomy specimen from a patient with a large benign simple cyst.
External surface of a nephrectomy specimen from a patient with autosomal dominant polycystic kidney disease (ADPKD).
Cut surface of the same nephrectomy specimen from a patient with autosomal dominant polycystic kidney disease (ADPKD).
Cut section of nephrectomy specimen demonstrating renal cell carcinoma (RCC), with an adjacent simple cyst.
Close-up photograph of the cut surface of the same nephrectomy specimen demonstrating a simple cyst adjacent to a renal cell carcinoma (RCC).
A prenatal sonogram of a fetus with a multicystic dysplastic kidney. The right kidney is appreciated as a large multicystic paraspinal mass. The left kidney and bladder are normal, and a normal amount of amniotic fluid is present.
CT examination of the abdomen of a 70-year-old woman with autosomal dominant polycystic kidney disease (ADPKD) is shown. The kidneys are bilaterally enlarged with multiple cysts.
CT scan of the same patient (70-year-old woman with autosomal dominant polycystic kidney disease [ADPKD]) demonstrating multiple hepatic cysts.
This CT scan demonstrates acquired renal cystic disease (ARCD) in a 70-year-old man who is dialysis-dependent. The CT scan demonstrates bilateral atrophic kidneys with multiple renal cysts.
A CT scan of a 38-year-old man with von Hippel-Lindau syndrome (VHLS). The patient previously underwent resection of multiple bilateral renal cell carcinomas (RCCs). CT scan demonstrates multiple cysts in the kidneys and pancreas, as well as solid renal lesions suggestive of malignancy.

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Table 1. Bosniak Classification of Cystic Renal Masses, Version 2019^[45]

Table 1. Bosniak Classification of Cystic Renal Masses, Version 2019 ^[45]

Category	Description	CT Findings	MRI Findings
I	Benign simple renal cyst requiring no follow-up	Well-defined thin (≤ 2 mm) smooth wall without septa, calcifications, or solid components; homogeneous simple fluid (–9 to 20 HU); the wall may enhance	Well-defined thin (≤ 2 mm) smooth wall without septa, calcifications, or solid components; homogeneous simple fluid (signal intensity similar to cerebrospinal fluid); the wall may enhance
II	Benign renal cyst or likely benign renal mass requiring no follow-up	All six types have well defined thin (≤ 2 mm) smooth wall: 1 -3 hairline-thin (≤ 2 mm) septa; the septa and wall may enhance; may have calcification of any type Homogeneous hyperattenuating masses (≥ 70 HU) on noncontrast CT Homogeneous nonenhancing masses (> 20 HU) may have calcification of any type Homogeneous masses ≤ 20 HU on noncontrast CT Homogeneous masses 21 to 30 HU) on portal venus phase CT Homogeneous low-attenuation masses too small to characterize	All three types have well defined thin (≤ 2 mm) smooth wall: 1 -3 hairline-thin (≤ 2 mm) enhancing septa; nonenhancing septa may have calcification of any type Homogeneous masses markedly hyperintense at T2-weighted imaging on noncontrast MRI Homogeneous masses markedly hyperintense at T1-weighted imaging on noncontrast MRI
IIF	Cystic renal mass follow-up imaging at 6 and 12 months and then annually to assess for morphologic changes	Minimal enhancement and/or thickening (3 mm) of a hairline-thin smooth septum or wall; or ≥ 4 smooth thin (≤ 2 mm) enhancing septa	Two types: Minimal enhancement and/or thickening (3 mm) of a hairline-thin smooth septum or wall; or ≥ 4 smooth thin (≤ 2 mm) enhancing septa Homogeneous masses on unenhanced fat-saturated T1-weighted imaging
III	Cystic renal mass, intermediate possibility of malignancy.	One or more thick (≥ 4 mm width) or irregular (≤ 3 mm obtusely margined convex protrusions) enhancing septa or enhancing walls	One or more thick (≥ 4 mm width) or irregular (≤ 3 mm obtusely margined convex protrusions) enhancing septa or enhancing walls
IV	Cystic renal mass, likely malignant	One or more large enhancing modules (≥ 4 mm obtusely margined convex protrusions or any size convex protrusion with acute margins)	One or more large enhancing modules (≥ 4 mm obtusely margined convex protrusions or any size convex protrusion with acute margins)

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Author

Thomas Patrick Frye, DO Clinical Fellow, Urologic Oncology Branch, National Cancer Institute, National Institutes of Health

Disclosure: Nothing to disclose.

Coauthor(s)

Steven Abboud Research Fellow, Medical Research Scholars Program, National Cancer Institute, National Institutes of Health

Steven Abboud is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation

Edmund S Sabanegh, Jr, MD is a member of the following medical societies: American Medical Association, American Society of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Acknowledgements

John M Corman, MD Clinical Associate Professor of Urology, University of Washington at Seattle; Consulting Staff, Department of Urology, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Alex Gorbonos, MD Assistant Professor, Department of Urology, Loyola University School of Medicine

Alex Gorbonos, MD is a member of the following medical societies: Alpha Omega Alpha, American Urological Association, Endourological Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Justin A Siegal, MD Radiologist, Department of Radiology, Virginia Mason Medical Center

Disclosure: Nothing to disclose.

Andrew T Trout, MD Resident Physician, Department of Radiology, University of Michigan Medical School

Andrew T Trout is a member of the following medical societies: American Medical Association, Phi Beta Kappa, Radiological Society of North America, and Sigma Xi

Disclosure: Nothing to disclose.

Cystic Diseases of the Kidney Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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