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Forum Name: Urology Topics

Question: Calcified area on kidney


 kelli89 - Mon Aug 25, 2008 2:06 pm

I am a 36 y/o female with a long history of calcium oxalate kidney stones. I had a CT w/o contrast done in 11/07 which revealed a stone in the right ureter (which I subsequently passed) and an incidental finding of a "1.5 cm paritally calcified mass in the lower pole of the left kidney, which may just represent a complex cyst." CT w/ contrast was recommended. My first urologist did not feel it was cause for concern. In July, I had two more stones on the right (10mm nad 8mm which required lithotripsy)....the partner MD of the original doc ordered a CT w/ and w/o contrast to followup on the CT from 11/07. On followup CT, done 8/19/08, the radiologist states "bilateral renal cysts, as well as complex area measuring 2 cm involving the lower pole of the left kidney, demonstrating borderline enhancement. Due to streak artifact from contrast enhancement, it is difficult to determine if true enhancement of this lesion is present. It is favored to be a complex cyst. Either close followup with CT or further evaluation with MRI is recommended." Also there was a "partially liquefied subcapsular hematoma of the right kidney measuring 1.8 cm" which I am assuming was from lithotripsy one month ago on that side.

My doc has ordered another CT in 3 months, and was not concerned about the hematoma or the cysts. (There were "several small cysts on bilateral kidneys")

I have a few questions:

1) Is followup in 3 months soon enough? What are the odds this could be a malignant process?

2) Is there anything to worry about/check for, etc, with the bilateral renal cysts?

3) Is the subcapsular hematoma anything to worry about...will it self resolve?

4) In 2006 I was diagnosed with a calcified meningioma on a head CT done when I had a TIA. (I have a history of a clotting d/o and have had a pulmonary embolus, etc.) My internist was not concerned about it, stating that it was entirely calcified...could the meningioma and the calcified area on my kidney be related, ie metastases from somewhere else?

THANKS FOR YOUR TIME!

Kelli89
 Dr. Tamer Fouad - Sun Dec 14, 2008 7:14 am

User avatar Hello,

That's a good question but as you have experienced first hand, it's one that's not easy to answer. The problem with renal cysts vs malignancy is augmented by the fact that the kidney is not readily accessible for biopsy.

In situations like yours there is a set of criteria employed by radiologists called the Bosniak Criteria for Renal Masses.[1]

Generally speaking the diagnosis favors malignancy when the mass shows:
# thickened irregular walls / septa
# enhancement after contrast

MRI is useful when U/S and CT are not diagnostic / contrast cannot be administered.
It's also useful in assessing invasion.

Apparently, your radiologist seems to think that the complex cyst does not fulfill the required criteria and he is even doubtful about the enhancement. Also, you don't seem to be having any of the alarming symptoms (eg, blood in urine).

I would say that 3 months is an adequate period for follow up. During this period you should report any new complaints right away.

Re: the hematoma, it should resolve spontaneously unless something is actively bleeding there.

Please keep us updated!

References:
==========
1. Gary M. Israel, MD and Morton A. Bosniak, MD. How I Do It: Evaluating Renal Masses. Radiology 2005;236:441-450.

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