-Asymptomatic adult middle-aged cat
-Suspicious of benign renal cyst but this one looks a bit different than those I have seen.
-Did single FNA, got only blood and mesothelial cells, and a single large, multinucleated cell (I suspect giant cell). I did NOT get a large volume of fluid, although the patient did not allow more sticks so maybe I was not all the way in it.
Thanks,
Suzanne
-Asymptomatic adult middle-aged cat
-Suspicious of benign renal cyst but this one looks a bit different than those I have seen.
-Did single FNA, got only blood and mesothelial cells, and a single large, multinucleated cell (I suspect giant cell). I did NOT get a large volume of fluid, although the patient did not allow more sticks so maybe I was not all the way in it.
Thanks,
Suzanne
Comments
thats a big one:) any panc or
thats a big one:) any panc or liver cysts do consider pkd complex? the only thing here is the medullary rim sign… may be idiopathic, FIP or LSA..but the latter 2 only if clinical which he isnt.. When I see these presentations I forget about the cyst and look at the parenchyma and sample that if indicated. The cyst, unless infected, will fruit little diagnostically but the cortex is where the $ is. Sedate, drain cyst and culture and 25 g fna to the cortex that looks most hypoechoic but not anechoic is what i woud do here if I wanted to get to the bottom of things. But the key is its an asymptomatic cat so likely benign cyst… if losing weight then more sampling is essential.
thats a big one:) any panc or
thats a big one:) any panc or liver cysts do consider pkd complex? the only thing here is the medullary rim sign… may be idiopathic, FIP or LSA..but the latter 2 only if clinical which he isnt.. When I see these presentations I forget about the cyst and look at the parenchyma and sample that if indicated. The cyst, unless infected, will fruit little diagnostically but the cortex is where the $ is. Sedate, drain cyst and culture and 25 g fna to the cortex that looks most hypoechoic but not anechoic is what i woud do here if I wanted to get to the bottom of things. But the key is its an asymptomatic cat so likely benign cyst… if losing weight then more sampling is essential.
The rest of the study was
The rest of the study was normal, including liver and pancreas. I will see if we can recheck it down the road. How often do you see problems stemming from a benign cyst? How important is it that it be drained?
Thanks!
Suzanne
The rest of the study was
The rest of the study was normal, including liver and pancreas. I will see if we can recheck it down the road. How often do you see problems stemming from a benign cyst? How important is it that it be drained?
Thanks!
Suzanne
It depends they usually fill
It depends they usually fill back up. I drain if they cause regional inflammation or are infected … other option is heminephrectomy.
It depends they usually fill
It depends they usually fill back up. I drain if they cause regional inflammation or are infected … other option is heminephrectomy.
How confident are we that
How confident are we that that is a cyst? Looks like it creates complete acoustic shadowing. At first glance I thought it may be a cyst but it’s only a cyst if it’s lined with mineral and shadowing out the beam completely or the largest nephrolith I’ve ever seen. Any updates on this one? Strange one!
How confident are we that
How confident are we that that is a cyst? Looks like it creates complete acoustic shadowing. At first glance I thought it may be a cyst but it’s only a cyst if it’s lined with mineral and shadowing out the beam completely or the largest nephrolith I’ve ever seen. Any updates on this one? Strange one!
Ive seen cysts this big
Ive seen cysts this big and you can see there is direct contiguous passage from renal cortex to cyst (arrow) which is characteriustic of all cysts whether liver, panc or kidney…. not to say this wont rupture but this transition is carried into the video as well.I dont see any disturbed parenchyma to say neoplasia and if the stone cause the cyst I would expect contiguous anechoic dilation from teh pelvis into the cyst which is not the case here … it comes directly from the cortical parenchyma. Maybe some inflammation or infection but would have to needle it to culture coming in through the cortical parenchyma into the cyst to avoid a leak from the thin capsule.
Ive seen cysts this big
Ive seen cysts this big and you can see there is direct contiguous passage from renal cortex to cyst (arrow) which is characteriustic of all cysts whether liver, panc or kidney…. not to say this wont rupture but this transition is carried into the video as well.I dont see any disturbed parenchyma to say neoplasia and if the stone cause the cyst I would expect contiguous anechoic dilation from teh pelvis into the cyst which is not the case here … it comes directly from the cortical parenchyma. Maybe some inflammation or infection but would have to needle it to culture coming in through the cortical parenchyma into the cyst to avoid a leak from the thin capsule.
reg the volume not coming
reg the volume not coming back needles get plugged with the tissue they go through like body wall or falciform fat going into liver or maybe renal parenchyma here. When draining a 22 gauge catheter may be best on this or even 20 g then pull th estylet backl just enough to not expose it to tear anything once in the cyst and keepit rigid to drain.
reg the volume not coming
reg the volume not coming back needles get plugged with the tissue they go through like body wall or falciform fat going into liver or maybe renal parenchyma here. When draining a 22 gauge catheter may be best on this or even 20 g then pull th estylet backl just enough to not expose it to tear anything once in the cyst and keepit rigid to drain.
I don’t have an update on
I don’t have an update on this case but I should check in with him, thanks for the reminder.
Marty nailed exactly what bothered me about this case, which was the complete echo drop out. I could not define the ventral extent on this cyst or whatever it is. The lack of fluid perplexed me but maybe it was just a plugged needle. I’m still increasing my confidence slowly with needles.
I’ll let you know if I find anything else out. I appreciate all the opinions.
Suzanne
I don’t have an update on
I don’t have an update on this case but I should check in with him, thanks for the reminder.
Marty nailed exactly what bothered me about this case, which was the complete echo drop out. I could not define the ventral extent on this cyst or whatever it is. The lack of fluid perplexed me but maybe it was just a plugged needle. I’m still increasing my confidence slowly with needles.
I’ll let you know if I find anything else out. I appreciate all the opinions.
Suzanne
Re the echo drop out a couple
Re the echo drop out a couple of things… you can change your angle and the dropout will go away …i.e.come medially throught the pelvis more for example or laterally through the paralumbar muscles. Using the linear probe only creates a few limitations but if you have virtual convex setting that may help too and increase the depth to 2 cm beyond the structure you are imaging
Re the echo drop out a couple
Re the echo drop out a couple of things… you can change your angle and the dropout will go away …i.e.come medially throught the pelvis more for example or laterally through the paralumbar muscles. Using the linear probe only creates a few limitations but if you have virtual convex setting that may help too and increase the depth to 2 cm beyond the structure you are imaging