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Dr. Y.
Dr. Y., Urologist
Category: Urology
Satisfied Customers: 15021
Experience:  Specializing in general urology and reconstructive urology.
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Had a pelvic and abdominal ulrasound and ct scan, results

Customer Question

hi- had a pelvic and abdominal ulrasound and ct scan, results below ( normal renal functioning ascertained from blood test):Clinical history- recent episode of severe abdominal pain multiple gallstones and angiomyolipoma in the right kidney? Gallstones and angiomyolipoma in the right kidney? Gallstones in the CBD. Findings- there is a heterogeneous low attenuation parenchymal lesion in the mid-portion of the right kidney. There is no appreciable fat attenuation within the lesion. The absence of fat attenuation suggest this is more probably a heterogeneous complex cyst rather than an angiomyolipoma. Grossly normal appearance in dimensions of the biliary tree. No radiopaque gallstones identified but please note radiolucent cholesterol gallstones cannot be excluded on ct scanning. Given the clinical concern of abdominal pain further MRCP and simultaneous contract MRI evaluation of the kidney is advised. The background renal parenchyma has normal appearance and enhancement characteristics with symmetric post contract excretion. Normal adrenals, liver, spleen, pancreas, bladder. Retroverted bulky uterus with suggestion of fibroids- further gynaecological review suggested if clinically concerned. Unprepped study with nondistended bowel precluding precise evelaution. Allowing for this limitation- except for a small sliding hiatus hernia no gross bowel pathology identified. Incidental note is made of long redundant pathology identified. Visualised lung bases and bones have normal appearances.Am more concerned about the kidney issue- possibly complex cyst- klow attentuation, could this be cancer, am worried they have missed something, this is an incidental finding.wouldnt ultrasound and ct scan have picked this up?Thnaks Julie
Submitted: 4 months ago.
Category: Urology
Expert:  Dr. Tharun replied 4 months ago.

Hi

Kindly mention your age and gender?

Where exactly was the pain and since how long ?

Do you smoke?

Are you diabetic , hypertensive or obese ?

Do you have fever or chills or jaundice ?

Do you have blood in urine ?

Any other significant medical history you would like to tell?

What is the size of the lesion in the kidney ?

Dr.Tharun

Customer: replied 4 months ago.
I am feamle, age 51, lesion is 6mm. I do not smoke, not diabetic, no blood in urine, my blood pressure was monitored for a few months recently- was borderline for needing medication but been told just to monitor it myself, am a bit overiwght but currently starting to losse weight. nO fever/ chills etc.The lesion as found almost incidentally - I was having intermittent pains under ribs, excessive belching even after water- but not all the time. I do have a history of IBS- 30 years which is very intermittent now. Think these two things may be related to gallstones ( if confirmed) and maybe hiatus hernia. These things are very intermittent , a, also peri menopausalThanks Julie
Expert:  Dr. Tharun replied 4 months ago.

HI Julie
Thanks for the info.
6 mm lesion is very small lesion in terms of renal mass; almost always benign in nature in such scenarios.

It is a low attenuation(in favor of benign). There is no mention of contrast enhancement of the mass though.
Complex cyst is divided into many categories based upon its appearance on the CT scan known as Bosniak classification.Only type 3 and 4 needs to be taken seriously and operated upon. So please check again if there is any mention of bosniak types in the report.

Such a small lesion can be easily followed up with 6 monthly/yearly scans to make sure its harmless.Studies have shown that masses less than 3 cm have very less propensity to be cancerous. Even if they are cancerous they don't metastasize(Spread outside the kidney) and hence don't change the outcome even if they are operated a little late.

As you are going ahead with the MRI scan , it will shed more light on the renal lesion ; but I suspect the information will be almost identical as in CT. In that case it can be safely followed up.

Such a small lesion will not cause any pain or gastro symptoms.Mostly we are dealing with hiatus hernia/ acid peptic disease or cholelithiasis.

If you have any more questions , please let me know.

Dr.Tharun

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