Renal cysts visualized on ultrasound and CT scanning

Patient

Q: On April 22 of this year, I visited my primary care physician with complaints of persistent right flank pain that has been present for about 3 months. A CT scan was ordered. The results are as follows: 1. There was no evidence of ureteral lithiasis or nephrolithiasis. 2. There was a mass in the upper pole of the right kidney showing a small area of calcification. This did not appear to be clearly fluid intensity. 3. Area of Calcification within the lower pole of the kidney to the right, parenchymal. Additionally there are what probably represent small cysts. A renal ultrasound was then ordered by my urologist. The impression is as follows: Nonspecific rounded hypoechoic lesions in both kidneys which could represent cysts although I could not reliably confirm that these were simple cysts by ultrasound criteria. My urologist was not concerned about these findings. I have a history of UTI's, kidney stones & hematuria. I am in constant pain in the right flank that radiates to the front. When sitting or standing back up the pain increases. Should I be concerned and what should my next step be?
Thank You for your time and consideration.Thank you.

Doctor

A:   Renal cysts are commonly observed in normal kidneys, especially patients of increasing age. They are usually benign asymptomatic lesions that rarely require treatment. The primary objective with visualization of a renal cyst on imaging of the kidney is to distinguish what type of cyst is present, whether it is a simple renal cyst or complex renal cyst. Cysts can be categorized from I to IV, with class I including benign simple cysts, class II containing uniform benign cysts with fine calcification, class III and IV contain irregular indeterminate cystic masses that may be cancerous. If your urologist is not concerned about the cysts or calcification on USS and CT, then these must be benign cystic lesions. However if your symptoms are not improving, I would advise follow-up with your urologist, with the possibility of repeat ultrasound scanning after 6 to 12 months, to ensure stability and a correct diagnosis.

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