Diagnostic ultrasound ( PDFDrive )

362 PART II Abdominal and Pelvic Sonography
A
B
C
FIG. 9.71 Autosomal Dominant Polycystic Kidney Disease.
(A) Early disease: numerous small intrarenal cysts. (B) Advancing
disease: renal enlargement and more cysts. (C) End-stage disease:
massive renal enlargement. The kidney is completely replaced by
cysts of varying size.
Most children present with an abdominal mass. Adults may be
asymptomatic or may present with abdominal pain, hematuria,
hypertension, or UTI.
he ultrasound appearance of MLCN is variable and depends
on the number and size of the locules. With multiple large locules,
noncommunicating cysts will be seen within a well-deined mass
(Fig. 9.74). If the locules are tiny, a more solid-appearing nonspeciic
echogenic mass will be present. Calciication of the capsule
and septa is uncommon. With either appearance, it is impossible
with imaging to diferentiate MLCN from cystic RCC.
FIG. 9.72 Multicystic Dysplastic Kidney. Small, malformed kidney
containing multiple cysts. (Courtesy of Deborah Rubens, MD.)
contained within a well-deined capsule. Occasionally, sarcomatous
stroma is present, making this a more malignant lesion. MLCN
has no predilection for side, and occasionally, bilateral tumors
are seen. hese tumors are found in male patients less than 4
years of age and in female patients age 4 to 20 or 40 to 60 years. 256
Localized Cystic Disease
Localized cystic disease is a rare, benign, nonhereditary entity
that may mimic MLCN. In localized cystic disease, multiple
closely opposed cysts occupy either a portion of kidney or an
entire kidney—thus the previous description of “unilateral
polycystic disease.” 257 At ultrasound, localized cystic disease
appears a conglomerate mass of multiple cysts of varying size
separated by normal or atrophic renal parenchyma (Fig. 9.75).
he lack of cysts within other organs (or the contralateral kidney)
and the absence of an appropriate family history prompt the