1.Intracranial BoneJawOvarianNeckSrotalMesiastinalCystsRetro-rectalPulmonaryDr/ Hytham Nafady RetroperitonealHepatic RenalBiliary

2. Intracranial cysts 3. Intracranial cysts Non neoplastic cystsNormal variantsDevelopmental cystsPostinfectiousNeoplasticcystsPosttraumatic 4. Normal variant cysts Normal variantsCavum septum pellucidumCavum vergaeCavum villum interpositumMega cisterna magnaDilated PVR spaces 5. Developmental cysts Intra-axial Extra-axial cyst Intra-ventricular Posterior fossa Neuro-glial cysts Arachnoid cyst. Epidermoid cyst. Dermoid. Choroid plexus cyst. Ependymal cyst Colloid cyst Dandy Walker spectrumPineal region Pineal cystSellar region Rathkes cleft cystPremedullary Neuroenteric cyst. 6. Post-infectiousNeurocysticercosisHydatid cyst 7. Post-traumaticPorencephalic cystsLeptomeningeal cysts 8. Neoplastic cystsExtra-axial cyst Glioblastoma multiforme. Ganglioglioma. Pleomorphic xanthoastrocytoma. DNET. Cystic metastasis. Cystic meningoma. Cystic schwannoma.Posterior fossaPilocytic astrocytoma. Hemangioblastoma.Pineal region Cystic pineocytoma.Sellar region Craniopharyngioma. Cystic pituitary macroadenoma.Intra-axial 9. Cystic schwannoma Extra-axial (CP angle)Cystic meningioma Extra-axial (convexity, paraflacine or CP angle)Cystic macroadenoma Sellar & supra-sellarCraniopharyngioma Sellar & supra-sellarPineocytoma Pineal glandHemangioblastoma Intra-axial, Posterior fossaPilocytic astrocytoma Intra-axial, Posterior fossaGlioblastoma multiforme Intra-axial, Supra-tentorialCystic oligodendroglioma Intra-axial, Supra-tentorial (frontal lobe)Pleomorphic xanthoastrocytoma Intra-axial, Supra-tentorial (cortical) Ganglioglioma Cystic metastases Intra-axial, Temporal lobe Intra-axial, Cortical / white matter interface 10. Cavum septum pellucidum Lack of fusion of the 2 leaflets of the septum pellucidum.Cavum vergae Lack of fusion of the 2 leaflets of the septum pellucidumCavum vellum interpositum Dilated VR spaces Cystic dilatation of the vellum interpositum cistern. Atrophy, or CSF trapping.Mega cisterna magnaDandy Walker spectrum Arachnoid cyst Epidermoid cyst Choroid plexus cyst Ependymal cyst Colloid cyst Congenital splitting of the arachnoid layer, with entrapment of CSF. Congenital inclusion of ectodermal epithelial elements. Entrapment of CSF within an in-folding of neuroepithelium. Sequestration of developing neuroectoderm during embryogenesis. Cyst of endodermal origion (similar to Rathkes cleft cyst)Neuroglial cyst Pineal cyst Rathkes cleft cystCyst of endodermal origin (due to peristent Rathkes cleft).Neuroenteric cyst Cyst of endodermal origin (due to persistent neuroenteric canal).Hydatid cyst Cysticercosis Porencephalic cyst Leptomeningeal cyst Cystic encephalomalacia communicating with CSF. Calvarial fracture, with dural tear. 11. Intracranial cysts of endodermal originColloid cystRathkes cleft cystNeuroenteric cyst 12. Intracranial cysts of endodermal originColloid cystRathkes cleft cystNeuroenteric cyst 13. Cavum septum pellucidum Cavum vergae Cavum vellum interpositum Dilated VR spaces Mega cisterna magnaDandy Walker spectrum Arachnoid cyst Epidermoid cyst Choroid plexus cyst Ependymal cyst Colloid cystNeuroglial cyst Pineal cyst Between the frontal horns anterior to the foramen of Monro Between the lateral ventricles posterior to the foramen of Monro Superior to the roof of the 3rd ventricle & inferior to the fornix. Centrum semi-ovale, basal ganglia & midbrain, Midline (posterior fossa) Posterior fossa Middle cranial fossa CP angle Choroid plexus Periventricular or intraventricular. Thrid ventricle Intra-axial Pineal glandRathkes cleft cystSellar & suprasellarNeuroenteric cyst Premedullary cistern.Hydatid cyst Intra-axial, usually hemispheric (middle cerebral territory).Cysticercosis CSF cisterns > parenchyma > ventricular system.Porencephalic cyst Leptomeningeal cyst Intra-axial Intra-axial, below clavrial fracture. 14. Cavum septum pellucidum NoCavum vergae NoCavum vellum interpositum NoDilated VR spaces NoMega cisterna magna NoDandy Walker spectrum Arachnoid cyst Epidermoid cyst Choroid plexus cyst Ependymal cyst Colloid cystHydrocephalus. Subdural hemorrhage CP angle May be associated with trisomy 18. Obstructive hydrocephalus (large cysts in vulnerable locations). hydrocephalusNeuroglial cyst NoPineal cyst NoRathkes cleft cyst Hydatid cystCysticercosis Porencephalic cyst Leptomeningeal cystCompression of the optic chiasm if large Compression. 15. Cavum septum pellucidum CSF likeCavum vergae CSF likeCavum vellum interpositum CSF likeDilated VR spaces CSF likeMega cisterna magnaDandy Walker spectrum Arachnoid cyst Epidermoid cyst CSF like (septations) CSF like (+ vermian hypoplasia & elevated torcular herophilli) CSF like signal on all pulse sequences CSF like( lobulated margin, bright on FLAIR, restricted diffusion)Choroid plexus cyst CSF like, with marginal calcification & restricted diffusion.Ependymal cyst CSF like, with well defined wall & no surrounding gliosis.Colloid cystNeuroglial cyst Pineal cyst Hyperdense on CT, may be bright on T1 & low signal on T2 CSF like CSF like with thick enhancing marginRathkes cleft cyst, Variable signal, may be bright on T1, with intracystic non enhancing nodule.Neuroenteric cyst Variable signal, may be bright on T1.Hydatid cyst CSF like, no enhancement, rarely calcification.Cysticercosis According to stage (vesicular, colloidal, granular or involution).Porencephalic cyst Leptomeningeal cyst CSF like (communicating with the subarachnoid space or ventricular system) CSF like protruding through the scalloped calvarial defect. 16. Dandy Walker spectrum Dandy Walker malformationDandy Walker variantPersistent Balkes pouchMega cisterna magna 17. DWMDWVAnterior membranous area anomalyPersistent Blakes pouchMega cisterna magnaPosteriror membranous area anomalyRetro-cerebellar cyst VermisHypoplastic Rotated upwardshypoplasticNo or mild hypoplasiaNo or mild hypoplasia4th ventricleMarkedly dilatedDilatedDilatedNormalPosterior fossaExpandedNormal sizeNormal sizeNormal sizehydrocephalus80 % of casesNoPresentNo 18. Vellum interpositum cistern Vellum interpositum is the double layered tela choroidea. Location: Superior to the roof of the third ventricle. Inferior to the body of fornix. The anterior end of the vellum interpositum is closed posterior to the interventricular foramen. The posterior end of the vellum interpositum is open & continuous with the quadrigeminal cistern. Contents: Internal cerebral veins . 19. Cavum vili interpositi 20. Vellum interpositum cistern 21. Embryologic Basis for the Development and Anatomy of the Cavum Veli Interpositi 22. Choroid plexus cyst 23. Ependymal cyst 24. Colloid cyst 25. Pineal cyst 26. Arachnoid cyst 27. Hydatid cyst 28. Neurocysticercosis 29. Leptomeningeal cyst (growing skull fracture) 30. Leptomeningeal cyst (growing skull fracture) 31. Leptomeningeal cyst (growing skull fracture) Pathology: It is not cyst (misnomer). Calvarial fracture, with dural tear. Radiology: Lytic calvarial lesion, with scallped edges, in which encephalomalacia invaginates. 32. Porencephalic cyst Pathology: Cystic encephalomalacia that communicates with the subarachnoid space or ventricular system. Types: Developmental (simple porencephaly). Congenital encephaloclastic porencephaly (acquired porencephaly). Radiology: CSF like signal on all pulse sequence. Usually no mass effect. Occasionally, associated with mass effect, if large. Communication with SAC or ventricular system. Lined by gliotic white matter. 33. Porencephalic cystInternalExternalCommunicates with the ventricular systemCommunicates with the subarachnoid space 34. Porencephalic cyst 35. DD of porencephalic cyst Arachnoid cyst lined by grey matterNeuroglial cyst no communication with the SAC or ventricular system 36. Cystic meningioma 37. Cystic schwannoma 38. Pilocytic astrocytoma 39. Glioblastoma multiforme 40. Ganglioglioma 41. Ganglioglioma 42. Pleomorphic xanthoastrocytoma 43. DNET 44. Suprasellar cysts Arachnoid cystCSFEpidermoid cystCSF Diffusion restrictionDermoid cystFat signalRathkes cleft cyst Variable signalNon enhancing intracystic nodule (pathogonomonic)CraniopharyngiomaMultilocularCalcificationCystic macroadenoma Enhancing solid component 45. Jaw cysts 46. Jaw cysts Non neoplasticEpithelialDevelopmentalOdontogenicDentigerous cyst Odontogenic keratocystNon odontogenicCyst of the incisive papillaNeoplasticNon epithelialinflammatoryStafne cystRadicular (periapical)Simple bone cystResidual cystAneurysmal bone cystAmeloblastoma 47. Residual radicular cyst 48. Globulo-maxillary cyst 49. Stafne cyst remodelling of the mandibular cortex around salivary tissue 50. Dentigerous cyst 51. Simple bone cyst 52. Fibrous dysplasia 53. Dentigerous cyst 54. Incisive canal cyst 55. Incisive canal cyst Heart shaped (superimposed anterior nasal spine). 56. Ameloblastoma 57. Ameloblastoma 58. Cystic neck masses 59. Neck spaces Supra-hyoid neckInfra-hyoid neckPharyngeal mucosal spaceVisceral spaceRetropharyngeal spaceRetropharyngeal spacePerivertebral spacePerivertebral spaceCarotid spaceCarotid spaceParaphrayngeal spacePosterior cervical spaceMasticator space Parotid space 60. Suprahyoid neck 61. Supra-hyoid neck spaces 1. 2. 3. 4. 5. 6. 7.Parapharyngeal space. Masticator space. Carotid space. Parotid space. Pharyngeal mucosal space. Perivertebral space. Retropharyngeal space. 62. Pharyngeal mucosal space cyst Torn Waldt cyst. Retention cyst. 63. Torn Waldt cyst Pathology: Developmental cyst. Location: Midline nasopharyngeal cyst. Radiology: Midline nasopharyngeal unilocular cyst with thin wall & no enhancement. 64. Torn Waldt cyst 65. Mucus retention cyst Pathology: Obstruction of the duct of mucus gland. Location: Vallecula (vallecular cyst). Aryepiglottic folds. Piriform sinuses. Tonsils (tonsillar cyst). Radiology: Off midline unilocular cyst with thin wall & no enhancement. 66. Vallecular retension cyst 67. Vallecular retension cyst 68. Retro-pharyngeal cyst Foregut cyst. 69. Retro-pharyngeal foregut cyst 70. Perivertebral space cysts 71. Para-pharyngeal space 2nd branchial cleft cyst. Cystic lymphangioma. 72. 2nd branchial cyst 73. Cystic lymphangioma 74. Carotid space Branchial cleft cyst. 75. Parotid cyst 76. Parotid cysts Non neoplasticDevelopmentalInflammatory1st branchial cleft cystSarcoidosisDermoid cystSjogern syndromeNeoplasticObstructiveSialoceleBenignWartins tumorLymphoepithelal cyst (HIV)NeoplasticNecrotic neoplasm or LN 77. Benign lympho-epithelial cysts Pathology: HIV +ve patients. Obstruction of intra-glandular ducts due to lymphoid hypertrophy. C.P: Painless parotid swelling. Bilateral in 20% of cases. Radiology: 78. Benigh lymphoepithelial cyst 79. Masticator space Mandibular cysts 80. Mandibular cysts Non neoplasticEpithelialDeveloplmental (Odontogenic)NeoplasticNon epithelialinflammatoryStafne cystDentigerous cystRadicular (periapical)Simple bone cystOdontogenic keratocystResidual cystAneurysmal bone cystAmeloblastoma 81. Infra-hyoid neck 82. Deep spaces of infra-hyoid neck 83. Infra-hydoid deep spaceCystVisceral spaceThyroglossal cyst. 4th branchial cleft cyst. Laryngocele.Retropharyngeal spaceRetension cystPosterior cervical space3rd branchial celft cyst. 84. Nasopharyngeal cysts Thorn Waldt cyst. Retension cyst 85. CystAgeThyroglossal duct cyst MParotid, external auditory canal Submandibular space, lateral to carotid vessels2nd1040 yEqual3rd1030 y4th Cystic hygromaAny age FLow anterolateral neck (L > R)213 yRanulaFloor of the mouthLaryngoceleVisceral space. 86. Thyroglossal cyst The most common congenital neck cyst. C.P: Midline cyst mass moves with tongue protrusion Complications: Infection Malignancy (very rare). 87. Thyroglossal cyst 1. 2. 3. 4.Infra-hyoid. Juxta-hyoid. Supra-hyoid. Intra-lingual.43 2 1 88. Branchial cysts Branchial = gills Responsible for the development of gills in fish. 89. Branchial cleft cyst Branchial cyst 1st branchial cleft cystLocation Parotid space.2nd branchial cleft cyst 1. 2. 3. 4. 5. 6.Anterior to the sternomastoid & deep to the paltysma muscle. Anterior to the sternomastoid & superficial to the carotid sheath. Carotid bifurcation. Submandibular space. Parapharyngeal space. Pharyngeal mucosal space medial to the carotid sheath.3rd branchial cleft cyst Posterior cervical space, posterior to the sternomastoid muscle. 4th branchial cleft cyst Visceral space, adjacent to the left thyroid lobe. 90. 3rd branchial cleft cyst 91. 4th branchial cleft cyst 92. 4th branchial cleft cyst 93. Laryngocele Pathology: Dilated laryngeal ventricle. Types: Internal or external. Primary or secondary. Radiology: May be air filled or fluid filled. 94. Laryngocele External Internal 95. LaryngoceleSecondaryPrimaryneoplasticIdiopathic 96. Sub-mandibular cyst 97. Submandibular cysts Non neoplasticDevelopmentalInflammatory2nd branchial cleft cystSarcoidosisDermoid cystSjogern syndromeNeoplasticObstructiveSialoceleBenignWartins tumorNeoplasticNecrotic neoplasm 98. Floor of the mouth cysts Dermoid / epidermoid. Ranula. 99. Dermoid / epidermoid 100. Dermoid cyst Sac of marbles appearance. 101. Epidermoid cyst 102. Ranula Pathology: Mucous retension cyst of the sublingual salivary gland. It is a pseudocyst (not lined by epithelium).RanulaSimplePlungingConfined to the sublingual spaceExtend to the submandibular space (through or around the myelohyoid muscle) 103. Ranula Radiology: Sublingual space cystic lesion. 104. Ranula C.P: Mass at the floor of the mouth with bluish discoloration. Neck mass. 105. Cystic mediastinal masses 106. Mediastinal cystic masses Anterior mediastinalThymic cyst.Middle mediastinalBronchogenic cystPosterior mediastinalMeningoceleCystic thymomaCystic schwannomaCystic teratomaEsophageal duplication cystCystic hygromaNeuroenteric cystPericardial cystPseudopancreatic cyst 107. Thymic cyst Congenital (unilocular). Acquired (multilocular): post-chemotherapy, post-thoracotomy, post-inflammtory.Cystic thymoma Cystic teratoma Cystic hygroma Pericardial cyst Aberration in the formation of the coelomic cavities.Bronchogenic cyst Abnormal ventral budding of the primitive foregutEsophageal duplication cyst Abnormal dorsal budding of the primitive foregut.Neuroenteric cyst Persistent neuroenteric canal.Cystic schwannoma Meningocele Pseudo-pancreatic cyst Neural tube defect (NF, Marfan) Pancreatitis. 108. Foregut cysts Bronchogenic cystEsophageal duplication cystNeuro-enteric cystAbnormal ventral budding of the primitive foregutAbnormal dorsal budding of the primitive foregutPersistent neuroenteric canal 109. CystLocationThymic cystPrevascularCystic thymomaPrevascularcystic teratomaPrevascularCystic hygroma (lymphangioma)PrevascularPericardial cystRight cardiophrenic angleBronchogenic cystSubcarinal or right paratracheal.MeningoceleParaspinalCystic schwnnomaParaspinalForegut cystParaesophagealPseudopancreatic cystTracking up into the posterior mediastinum. 110. Anterior mediastinal cysts 111. Thymic cyst 112. Cystic thymoma 113. Lymphangioma 114. Dermoid cyst 115. Pericardial cyst 116. Middle mediastinal cysts 117. Bronchogenic cyst 118. Posterior mediastinal cysts 119. Duplication cyst 120. Cystic schwannoma 121. Meningocele 122. Pseudopancreatic cyst 123. Cystic lung disease 124. DD of air filled spaces Thick walled > 1 mm CavityThin walled < 1 mm BullaBlebSub-pleuralSub-pleural> 1cm< 1cmCystIntrapulmonary with epithelialized wallPneumatoceleIntrapulmonary without epithelialized wall 125. Cystic lung diseases PediatricsAdults MultifocalFocal(1 lobe or multiple lobes in 1lung)PneumatoceleCongenital lobar emphysema(staph, PCC)Uni-locularIntrapulmonary bronchogenic cystPulmonary sequestationType I CCAMPneumatoceleDiffuse (all lobes of both lungs)Cystic bronchiectasis EmphysemaCysts associated with PA hypoplasiaMulti-locularLargeFocal or multifocalSmallType II CCAMIntrapulmonary bronchogenic cystPLCHCysts associated with PV hypoplasiaCystic metastasesLAMLymphoid interstitial pneumoniaHoneycombing IPF 126. Diffuse cystic lung disease & its mimics FindingsC.PDistributionAssociated findingsSubpleural & basilar predominanceReticular opacities. GGOIPFHoneycombingLIPThin walled cystsAIDs Sjogren syndromeBasilar predominance Peri-vascularGGOPLCHBizzare shaped cystsMale smokerRandom Spares the bases.NodulesLAMThin walled cystsFemale TSRandom DiffuseChylous effusion. TSCystic bronchiectasisCysts communicating with the bronchial treeFocal Diffuse (central, upper, middle & lower)Air fluid levels.EmphysemaCystic air spaces without discernable wallUpper (cetrilobular) Hyperinflation Lower (panlobular) Subpleural (paraseptal) 127. Lymphoid interstitial pneumonia Diffuse ground glass opacification. Perivascular cysts. 128. UIP Honeycombing. Reticular opacities. 129. Congenital cysts 130. Intrapulmonary bronchogenic cyst 131. Infected bronchogenic cyst 132. Renal cysts 133. Simple cystsARPKD ADPKDTSMCDKMedullary sponge kidneyMedullary uremicDialysis cysts 134. Cysts versus hydronephrosis 135. Etiology DevelopmentalGenetic Cysts associated with systemic disease MCDK ADPKD ARPKD Medullary cystic disease (nephronophthisis). TS VHLAcquired cysts Simple cyst. Medullary sponge kidney. Acquired cystic disease of uremia.Malignant cysts Multilocular cystic nephroma. Cystic renal cell carcinoma 136. Renal cysts Large cysts > 2 cmSmall cysts < 1cmMCDKARPKDADPKDMedullary cystic diseaseSimple cystsMedullary sponge kidneyCystic neoplasmsAcquired cystic disease of uremia 137. Large renal cystsSimple cystsADPKDMCDKCystic neoplasms 138. Renal cysts ChildrenAdultMCDKADPKDARPKDMedullary cystic diseaseTS / VHLMedullary sponge kidneyCystic neoplasmsAcquired cystic disease of uremia TS / VHL Cystic neoplasm 139. Large renal cystsMCDKARPKTSMedullary cystic disease 140. MCDK Atresia of the proximal ureter during intrauterine development, with replacement of the kidney by multiple cysts & un-differentiated mesenchymal tissue.ARPKD Cystic dilatation of distal convoluted tubules & collecting ducts.ADPKD Cystic dilatation of Bowman's capsule, loop of Henle & proximal convoluted tubulesMedullary cystic disease (nephronophthisis) Ciliary dysfunction of renal tubules.TS Mutation of tuberin & hamartin suppressor gene proliferation of renal tubular epithelium.VHL Mutation of VHL suppressor gene proliferation of renal tubular epithelium.Medullary sponge kidney Simple cortical cystsAcquired cystic disease of uremia Renal tubular duct ectasia. Unknown. Hypertrophy of functioning nephrons, hyperplasia of tubular epithelium obstruction & expansion of renal tubules. 141. MCDK Neonate, with abdominal mass.ARPKD Infant, with bilateral flank masses, renal failure, hypertension or portal hypertension.ADPKD Adult, with bilateral flank pain, hematuria, renal failure, hypertension, SAH or family history.Medullary cystic disease (nephronophthisis) TSVHL Medullary sponge kidney Simple cortical cystsAcquired cystic disease of uremia Renal failure Triad: Adenoma sebaceum, Fits & Mental retardation. Renal, pancreatic or epididymal cysts. Cerebellar, spinal or retinal hemanigoblastoma. Asymptomatic Complications (stones or sepsis) Asymptomatic. Complications (rupture or infection) Chronic renal dialysis. 142. MCDK Multiple non communicating cysts with dysplastic echogenic renal tissue.ARPKD Nephromegaly, with echogenic parenchyma & striated nephrogram.ADPKD Multiple non communicating cysts with spider leg deformity of the pelvicalyceal system.Medullary cystic disease (nephronophthisis) TSVHL Medullary multiple cysts. Cysts. AML Oncocytoma. Renal, pancreatic or epididymal cysts. Cerebellar, spinal or retinal hemanigoblastoma.Medullary sponge kidney Medullary nephrocalcinosis, paint brush appearance or bouquet of flowers appearance.Simple cortical cysts Clear contents, thin regular wall, with no mural vegetations, internal septations or calcification.Acquired cystic disease of uremia Small atrophic kidney, with multiple cysts. 143. MCDK ARPKDADPKD Medullary cystic disease (nephronophthisis) Bilateral MCDK is incompatible with life. Renal falilure, hypertension or portal hypertension. Hemorrhage, rupture, infection. Subarachnoid hemorrhage. Aortic dissection. Renal failureTS The incidence of RCC in TS is similar to the general population.VHL Cystic renal cell carcinoma.Medullary sponge kidney Simple cortical cysts Acquired cystic disease of uremia Stones or Sepsis. Hemorrhage, Rupture, Infection. Hemorrhage. Infection. Malignancy. 144. MCDK Contralateral PUJ obstruction or VURARPKD Hepatic periportal fibrosisADPKD Liver cysts & cerebral aneurysms.Medullary cystic disease (nephronophthisis) TSVHL Medullary sponge kidney Simple cortical cysts Acquired cystic disease of uremia Cortical tubers, subependymal calcified nodules, white matter lesions, subependymal giant cell astrocytoma, LAM, renal angiomyolipoma, cardiac rhabdomyoma. CNS hemangioblastoma, pancreatic cysts Caroli disease. 145. Multicystic dysplastic kidney 146. Bilateral ureteric atresia with bilateral MCDK 147. ARPKD with hepatic fibrosis 148. Acquired uremic cystic disease 149. Medullary sponge kidney 150. Tuberous sclerosis 151. VHLRCC 152. Multilocular cystic nephroma 153. Bosniak classification:Grade I Simple cystGrade II Minimally complicated cystGrade III Grade IV Moderately Malignant cyst complicated cystWall:Thin walled.Thin walled.Thick walled.Contents:Clear contents: Turbid contents U/S: U/S: -anechoic. Internal echoes. -back enhancement.U/S: Internal echoes.Septations:CT: < 20 HU. NoCT: > 20HU. Thick septations.Calcification:NoCT: < 20 HU. Paper thin septations. Minimal calcification.Has solid and cystic components.Heavy calcification.Enhancement: NoWall enhancement. Wall enhancement.Workup:Follow up by U/S or CT.No further workup.-biopsy. Nephrectomy. -aspiration of cyst. 154. Management of renal cystsSimple cystsCystic masses(Bosniak I)(Bosniak II, III or IV)IgnoreIgnoreFollowExcise 155. A fluid-filled lesion is considered a cystic mass (ie not a simple cyst) when it has any of the following features: 1 - Calcification 2 - High attenuation ( > 20 HU ) at NECT 3 - Septation 4 - Multiple locules 5 - Enhancement 6 - Wall thickening 7 - Nodularity 156. Management Consequences in calcificationIgnoreFollowExciseSmall amounts Smooth, septal Milk of Ca No enhancementThick or nodularNodularity or thickening of the wallNo enhancementenhamncement 157. Management Consequences in hyperdense cystsIgnore Sharp margins < 3 cm Not completely intrarenal Homogenous Cystic on US No enhancementFollowExcise Poorly defined> 3 cm Totally intrarenalCystic on US No enhancementHeterogenous Solid on US Enhamncement 158. Management Consequences in septationsIgnoreFollowExciseThin Smooth No enhancementSlightly > hairlineThick , Irregular or nodular EnhancementNo enhancement 159. Management Consequences in enhancementIgnoreFollowExcise< 10 HU10 15 HU15 HU *unless Infection 160. NECT : 16 HU Cortical phase 17 HU Nephrographic phase 19 HUIgnore 161. NECT : 44 HU Enhanced scan:61 HU------ Excise 162. Management Consequences in multiloculated lesionsIgnore ---------Follow ----------Excise All*unless Infection 163. Management Consequences in nodular cystsIgnore ---------FollowExciseVery small Non enhancingAll others 164. Renal sinus cysts 165. Renal sinus cysts 166. Renal sinus cysts Parapelvic cystPeripelvic cystsRenal cortical cystLymphatic cyst (lymphangiectasia)SingleMultipleUnilateralBilateral 167. Hepatic cysts 168. Etiology Developmental Traumatic InflammatoryNeoplastic Simple cysts. Bile duct hamartomas. Caroli disease. Biloma. Hematoma. Hydatid cyst. Hepatic abscess. Extrapancreatic pseudocyst Biliary cystadenoma & cystadenocarcinoma. Embryonal sarcoma. Cystic HCC. Cystic metastasis. 169. C.PAssociationsSimple cystsAsymptomaticHomogeneous, rounded, regular, no wall, no enhancment.Bile duct hamartomaAsymptomaticHomogeneous, rounded, regular, mural enhancment, all lesions are < 1.5 cm in diameterCaroli dieaseAsymptomatic, Cummunicating with the biliary unless complicated. tree. Central dot sign.Embyronal sarcomaYoung adultsComplex cyst with enhancing solid componentCystadenoma & cystadenocarcinomaAsymptomatic Middle aged femalesMultilocular, mural nodules.Cystic metastasisAbscessMultiplicity. Mural enhancement. Not equal to fluid on heavy T2Constitutional symptomsDouble target signHistory of traumaSurrounding pseudocapsuleHydatid cyst bilomaADPKD VHLMedullary sponge kidney 170. Hepatic cyst 171. Biloma 172. Multiple biliary hamartomas 173. Multiple biliary hamartomas 174. Double target sign with transient segmental enhancement Inner enhancing rim Abscess capsule.Outer hypodense rim Edematous liver parenchyma.Transient segemental enhancement Hyperemia. 175. Retroperitoneal cysts 176. Retroperitoneal cysts Non neoplasticNeoplasticHematomaCystic lymphangiomaUrinomaMucinous cystadenomaLymphoceleCystic teratomaPseudopancreatic cyst 177. CystHistoryRadiologyNon neoplastic HematomaTraumaUrinomaTraumaLymphoceleLymphadenectomyPseudopancreatic cystRetroperitoneal fluid collection.PancreatitisNeoplastic: Cystic LymphangiomaMucinous cystadenomaMultilocularCystic teratomaCalcification. Fat density. 178. Lymphocele 179. Retroperitoneal urinoma 180. Retroperitoneal hematoma 181. Pseudopancreatic cyst 182. Retroperitoneal serous cystadenoma 183. Retroperitoneal mucinous cystadenoma 184. Retroperitoneal cystic teratoma 185. Retro-rectal cysts Epidermoid cyst Unilocular. Thin wall. Clear contents.Dermoid cyst Fat contents. Sacral defectsTail gut cyst Sacro-coccygeal teratomaAnterior sacral meningocele Multilocular cyst (thin internal septations). Mucinous content (may be bright on T1). Mural calcification Pediatrics. Solid & cystic components. Sacral defect. Communicating with the thecal sac. 186. Epidermoid cyst 187. Anterior sacral meningocele 188. Rectal duplication cyst 189. Tailgut cyst 190. Pancreatic cysts 191. Pancreatic cysts 192. Serous cystadenoma 193. Mucinous cystadenoma 194. IPMN Intraductal papillary & mucinous neoplasmMain ductSegmentalSide branchDiffuseMicrocysticMacrocystic 195. IPMN main duct diffuse 196. IPMN main duct segmental 197. Side branch IPMN 198. Ovarian cysts 199. Ovarian cysts Functional cystsNon functional(can produce hormones) Follicular cystCorpus luteum cystNon neoplastic Single Endometrioid cyst Serous inclusion cystNeoplasticmultiple PCOTheca lutein cysts (ovarian hyperstimulation syndrome)BenignmalignantMature cystic teratomaImmature cystic teratomaSerous cystadenomaSerous cystadenocarcinomaMucinous cyst adenomaMucinous cystadenocarcinoma Endometerioid carcinoma Cystic metastases 200. Functional cysts 201. Follicular cyst Epidemiology Reproductive age. C.P: asymptomatic Pathology Un-ruptured Graafian follicle. Natural course Spontaneous resolution in 2 or 3 cycles Radiographic features Ultrasound Simple cyst Unilocular. Thin wall, with no mural vegetations, internal septations or solid components. Clear contents, with acoustic enhancement & no internal echoes. Duplex: No color flow. 202. Corpus luteum cyst Epidemiology 1st trimester of pregnancy. Post-menopasual female. C.P: asymptomatic Pathology Failure of regression of corpus luteum. Natural course Spontaneous regression by the end of 2nd trimester. Radiographic features Ultrasound Simple cyst Hemorrhagic cyst Duplex: Ring of fire (DD with tubal pregnancy). 203. PCO 204. Ovarain cysts SimpleHemorrhagicFunctional cystHemorrhagic functional cystCystic neoplasmChocolate cystCystic neoplasmComplex Cystic neoplasm 205. Management of ovarian cysts 206. Ultrasound pattern recognition 207. Criteria of malignancy Size Large size.Wall Thick irregular wall. Mural vascularity. Mural vegetations. Mural papillary projections. Mural solid components.Septations Secondary signsThick septations (> 3 mm). Vascularized septations Ascites. Peritoneal deposits. lymphadenopathy 208. MR signal of ovarian cysts 209. Breast cystsBreast cystSimpleComplicatedComplexcystcystcyst 210. Breast cystBreast cystMicro-cystMarco-cyst< 3 mm> 3 mm 211. Simple cystComplicated cystComplex cystBIRADS 2BIRADS 3BIRADS 4U/SAn-echoic Smooth wall. Circumscribed in shaped. Posterior acoustic enhancement. Reverberation artefact.Internal echo or layering debrisThick wall. Thick septations (> 5 mm). Solid mural nodules. Solid & cystic compnentsMRIHypointense on T1. Hyperintense on T2.Variable signal depending on cyst contentsThick wall Thick septations Solid mural noduleEnhancement No enhancementThin marginal enhancement. 212. Complex breast cystType 1Thick wall or thick septaType 2Solid mural noduleType 3Type 4Solid & cystic componentSolid & cystic component(> 50 % cystic)(> 50% solid) 213. Simple cyst 214. Simple cyst 215. Simple cyst 216. Complicated cyst 217. Complicated cyst 218. Breast cysts SimpleFibrocystic diseaseComplicatedGalactoceleComplexBenignMalignantOil cystGalactoceleNecrotic breast massHematomaOil cystIntracystic breast carcinomaAbscessHematomaAbscess 219. Galactocele Pathology: retension cyst due to obstruction of lactiferous duct. C.P: lactating female. Mamography: radiolucent lesion, with eggshell calcification. U/S: complicated cyst or complex cyst. Colour doppler: no flow. Complications: 2ry infection breast abscess. 220. Galactocele 221. Oil cyst Pathology: traumatic fat necrosis. C.P: history of trauma or operation. Mamography: well circumscribed radiolucent mass with or without eggshell calcification. U/S: complicated cyst or complex cyst, with no acoustic shadowing or enhancement. Fat fluid level. Color doppler: no flow. 222. Oil cyst 223. Oil cyst 224. Breast abscess Pathology: staph aureus C.P: constitutional symptoms, local hotness, redness and tenderness. Lactating female. Mamography: non specific. U/S: complicated or complex cyst. Hypoechoic rim. Adjacent interstitial fluid. 225. Breast abscess 226. Scrotal cysts Intra-testicular cystsParatesticular cystsSimple cystEpididymal cystTunica albuginea cystSpermatoceleCystic transformation of the rete testisCystadenoma of the rete testis Testicular epidermoid cyst Testicular neoplasm with cystic component 227. Simple testicular cysts C.P: not palpable & not firm (even if large). U/S: Anechoic, thin imperceptible wall, through transmission. 228. Simple testicular cyst 229. Tunica albuginea cyst C.P: small palpable mass. Radiology (U/S): Similar to simple cyst (anechoic cyst with thin imperceptible wall). But small in size and located at the upper anterior or lateral aspect to the testis. 230. Tunica albuginea cyst 231. Epidermoid cyst C.P: painless palpable testicular mass. Radiology (U/S): onion peel appearance. 232. Epidermoid cyst 233. Cystic transformation of the rete testis Pathology: partial or complete obliteration of the efferent ducts. Radiology (U/S): Multiple cyst or tubular anechoic structures that replace the mediastinum testis. No mass effect. No internal flow. 234. Cystic transformation of the rete testis 235. Cystadenoma of the rete testis 236. Epididymal cyst 237. Cystic transformation of the rete testis associated with spermatocele 238. Epididymal cystSpermatoceleAny where in the epididymis Epididymal head AnechoicLow level internal echos.UnilocularUnilocular or multilocuar 239. Choledochal cysts 240. Definition Congenital cystic dilatation of the biliary tree. 241. PATHOPHYSIOLOGY Anomalous junction of the CBD, with pancreatic duct (90%). Reflux of the pancreatic secretions & enzymes into the CBD. Inflammation & weakening of the bile duct wall. Formation of choledochal cyst. 242. Demographics Age: it can be discovered at any age. 60 % below 10 ys.Sex: F > M, 4 : 1 243. C.PCholedochal cyst Abdominal painJaundiceAbdominal mass 244. Complications Pancreatitis. Cholangitis. Cholangiocarcinoma. 245. Cholangiocarcinoma within a choledochal cyst 246. Types Todani classification Type I: dilatation of the CBD. Type II: true diverticulum. Type III: Choledochocele. Type IV: dilatation of the extrahepatic & intrhepatic biliary system. Type V: Caroli disease. 247. Type I Fusiform dilatation of a segment or the entire CBD. True choledochal cyst. Most common type 80%. 248. Portal vein Splenic vein 249. Type II True diverticulum. Saccular outpouching of the supra-pancreatic portion of the CBD. 3%. 250. Type III Choledochocele (dilatation of the ampullary portion of the CBD). 5 %. 251. Type IV 2nd most common type 10% 252. Type V Caroli disease 253. Central dot sign 254. Caroli disease Autosomal recessive disorder 2ry to ductal plate malformation. 255. Normal development of ductal plate 256. Patterns of Caroli disease Segmental 83 %. Diffuse 17 %. 257. Central dot sign 258. Associations of Caroli disease Liver: Congenital hepatic fibrosis (due to involvement of small ducts). Caroli syndrome (caroli disease associated with congenital hepatic fibrosis) due to involvement of large & small ducts. Kidney: Medullary sponge kidney. Polycystic kidney. Medullary cystic disease 259. Caroli disease & medullary sponge kidney 260. Complications of Caroli disease Intraductal stones. Ascending cholangitis & abscess formation. Cholangiocarcinoma. Liver cirrhiosis. 261. Intraductal stones 262. Liver cirrhosisCentral dot signabscess 263. Cholangiocarcinoma 264. Abscess formation 265. Bone cysts