Anechoic formation in the kidney: causes, symptoms and treatment features

What is an anechoic formation in the kidney? It does not contain liquid. As a rule, such an inclusion is a cyst. To accurately determine the pathology, additional diagnostic procedures are necessary. In this case, methods with a high degree of accuracy are used. For example, if an ultrasound examination revealed a spot located in the upper part of the organ, this may indicate the presence of a cyst not only in the kidney area, but also in the liver, diaphragm or spleen.

If the spot is located near the kidney, then, as a rule, this is a sign of a hematoma. Sometimes the pathology is accompanied by bleeding in the cyst. This phenomenon is a symptom of the presence of cystic cancer.

Large abnormal formation

A large formation in the left or right kidney is often detected on ultrasound. Typically, this is a benign tumor.

Typically, an anechoic avascular formation in the kidney has clear, rounded contours.

Pathological inclusions can be quite large, have irregular contours and difficult to define boundaries. In complex objects, bleeding, abscess, necrosis or calcification may be detected.

If the formation is up to 30 mm in size, then this may indicate the presence of kidney carcinoma, adenoma or oncocytoma. In addition, a pseudotumor may also develop.

Sometimes metastases are observed. An angiomyolipoma or a small cyst often forms. The cause of the development of cysts is polycystic disease and structural changes in the cortical layer.

Content

1. Ovarian cyst - what is it?
2. Forms of ovarian cyst
3. At-risk groups
4. Symptoms of an ovarian cyst
5. Why do ovarian cysts form?
6. What is an ovarian follicular cyst?
7. Treatment of follicular cyst
8. Corpus luteum cyst and its treatment
9. Is a corpus luteum cyst dangerous during pregnancy?
10. Dermoid cyst
11. What is endometrioma (endometrioid ovarian cyst)?
12. Polycystic ovary syndrome
13. Cystadenoma
14. Paraovarian cyst
15. Carcinoma (malignant cyst)

The anechoic formation in the left ovary is a round cyst with a homogeneous structure and a clear contour.
A woman receives a medical report “anechoic formation in the left or right ovary” after undergoing an ultrasound examination of the internal genital organs or the pelvis for various reasons. The conclusion may be, for example, this: “anechoic inclusion with a capsule (hyperechoic rim), signs of a corpus luteum cyst on the right.” Such a formation in the ultrasound “picture” looks light, almost white. For reference, similar inclusions (formations) are also hypoechoic (from other Greek - “lower, smaller”), they are detected on ultrasound as dark structures.

It should be understood that an anechoic or hypoechoic formation in the left ovary is a pathology that is not a diagnosis. This is a description of how the ultrasound beam was reflected from the ovary: the equipment emits ultrasound waves, human tissues and organs either transmit them unchanged (anechoic or echo-negative organs and formations) or reflect them to one degree or another. An anechoic structure is one that contains fluid.

In the case of the ovary, such a conclusion from a pelvic ultrasound means that the sonologist diagnoses a cyst. A woman’s next step after receiving such data about her health is to visit a gynecologist, since cysts can be completely different, and their therapy varies significantly.

It's time to decide how to treat a disease such as an ovarian cyst, and what impact it will have on pregnancy planning.

Symptoms

The presence of simple cysts in the kidneys is evidence of a benign neoplasm. They are often traced by ultrasound, which is performed when diagnosing a completely different disease. Since the symptoms of this pathology are blurred, in most cases the disease does not manifest itself in any way. In this case, the cyst itself does not require therapy.

But if the anechoic formation in the left or right kidney has reached an impressive size, then the symptoms may be as follows:

• dull pain in the lower back, abdomen or side;
• fever;
• the appearance of ichor in the urine (hematuria);
• impaired urination due to pressure exerted by the cyst on the renal pelvis;
• nausea;
• general weakness.

Symptoms of an ovarian cyst

Usually, owners of ovarian cysts do not even suspect their presence, since small cysts do not provoke any symptoms. As the cyst develops, a woman may experience the following symptoms:

• Feeling of pressure and heaviness in the pelvis.
• Dull pain in the lower abdomen on the left or right, appearing or intensifying with physical activity and/or sexual intercourse.
• False urge to defecate.
• Pain when urinating and frequent urination.
• In case of complications of the cyst (its torsion, rupture), severe paroxysmal pain in the abdomen and groin area, high body temperature, vomiting, and nausea may occur. If such symptoms appear, you should immediately contact a gynecologist or call an ambulance.

Types of large cysts

Among large cysts, the following varieties should be distinguished:

• Solitary. It has a round shape and does not include constrictions and connecting ducts, which are filled with serous fluid. It often includes blood and purulent streaks.
• Polycystic. It affects most of both kidneys.
• Multicystic. It develops in the kidney or medulla in the spongy kidney.
• Dermoid. It is characterized by the presence of various inclusions: hair, pieces of skin, fat, etc.

When performing an ultrasound, benign formations appear as single or multiple. They look like big spots. At the same time, the structure of the kidney parenchyma is not changed.

A secondary benign tumor on an ultrasound monitor is depicted as a neoplasm with uneven contours around tissue scars. It has a changed internal echo structure.

A large anechoic formation in the kidney may indicate the presence of kidney cancer, adenoma, or other types of tumor.

The article presents an algorithm for complex clinical and radiological diagnosis of “small” kidney tumors. Studied: frequency, clinical manifestations, radiation semiotics of “small” kidney tumors (up to 40 mm), cystic kidney tumors and complicated renal cysts.

Optimization radiological diagnosis of “small size” tumors of the kidneys

The article presents an algorithm of complex clinical radiological diagnostics of “small” tumors of kidneys. Frequency, clinical implications, radiological semiotics of tumors of kidneys of the “small sizes” (to 40 mm), cystic tumors of kidneys and the complicated renal cysts are studied.

In recent years, there has been an increase in the incidence of kidney cancer, mainly due to the so-called small forms (up to 40 mm in diameter), which are most often asymptomatic [1-5]. About 10% of “small” kidney tumors are benign [1, 2], and almost 90% are renal cell carcinoma (RCC). The incidence of kidney cancer varies from 2 to 5% of all malignant neoplasms in adults, from 5 to 6% among all urological diseases [6, 7].

Approximately 5-7% of renal masses cannot be reliably differentiated using modern imaging methods [10-14]. These include neoplasms that cannot be classified either as simple renal cysts or solid structures. These indeterminate masses may present with either benign or malignant pathology. In recent years, more and more attention has been paid to primary cystic forms of malignant kidney tumors. Cystic degeneration is most common in children with Wilms tumor. There is a need to differentiate between primary cystic forms of renal cell carcinoma and complicated renal cysts.

Both types of formations are characterized by the presence of a pronounced fluid component, while both tumors and cysts can be uni- and multilocular [11]. The frequency of malignant pathology in atypical renal cysts reaches 40% [9, 11]. It is believed that cystic forms of RCC account for about 10-15% of all tumors of this type [10].

Despite the widespread introduction of medical imaging methods, the diagnosis of cystic forms of RCC and atypical renal cysts remains an urgent problem. There is a need to develop radiation screening using modern ultrasound methods (US), X-ray computed tomography (XCT) with fine-needle aspiration puncture biopsy (FNA) of “small” tumors and cystic kidney masses of categories I-IV (according to MA Bosniak).

The purpose of the study was to optimize the radiation diagnosis of “small” (up to 40 mm) renal tumors, establish their frequency, study the features of clinical manifestations, the nature of the blood supply, study the radiation semiotics of primary cystic forms of RCC, conduct a differential diagnosis of them with complicated renal cysts, solid tumors. cystic structure using ultrasound and CT angiography with multiphase contrast.

From 2000 to 2009, voluminous renal tumors of various sizes, structures and densities were identified in 213 patients (117 men, 94 women). The age of the patients ranged from 40 to 65 years. There were isolated kidney cysts in 67 patients, polycystic kidney disease - in 117. To study the correlation between the size, structure, localization (intraparenchymal, extrarenal), the possibility of their visualization by radiation methods, the nature of blood flow, clinical manifestations, stage of malignant tumors up to 40 mm and more the patients were divided into groups (Table 1).

Table 1.

Distribution of patients depending on the size of the kidney tumor

Small renal tumors were found in 89 (41.8%) patients. The vast majority of patients (69.7%) were characterized by an asymptomatic clinical course. These tumors were identified by combining modern ultrasound technologies (ultrasound, ultrasound with colorectal dosage, ED) with RCT with intravenous contrast and aortography when examining patients with various urological (chronic pyelonephritis, nephrolithiasis, prostate hyperplasia) and non-urological (hypertension, cholelithiasis) diseases . Clinical manifestations of tumor lesions of the kidneys measuring more than 41 mm occurred in 124 (58.2%) people.

The morphological structure of the identified neoplasms was as follows: benign angiomyolipoma - in 13 of 89 patients (14.6%) with small kidney tumors, lipoma - in 14 (15.7%), xanthogranulomatous pyelonephritis - in 6 (6.7%), complicated kidney cyst - in 8 (8.9%).

A malignant tumor with a size of less than 40 mm was diagnosed in 54 (60.6%) individuals and was represented by RCC with a predominance of a high degree of differentiation of cancer cells (81%). In the majority of patients (81.4%), the neoplasm did not invade (according to the results of surgical interventions) the fibrous capsule of the kidney. In 52 (54%) patients, tumor sizes from 41 to 70 mm corresponded to T1b stage of kidney cancer; in the rest, the tumor grew into the fibrous capsule of the kidney or spread into the inferior vena cava.

The relationship between the size of the tumor and the nature of its contrast in the corticomedullary phase of contrast-enhanced CT is shown in Table. 2.

Table 2.

The nature of tumor contrast depending on its size (abs. and %)

Tumors up to 2 cm were detected during a comprehensive radiation study in only 13 (6.3%) of 213 patients with RCC, which was due to the resolution of the latter and the localization of tumors in the renal parenchyma. Tumors from 3 to 4 cm were clearly visualized during ultrasound with extrarenal growth and were accompanied by deformation of the kidney contour. However, there was a need to differentiate from pseudotumors (“humpbacked kidney”, local hyperplasia, accessory lobe of the kidney, accessory spleen, hypertrophied upper lip of the kidney, hypertrophy of Bertin’s column).

The main importance in the diagnosis of RCC was the determination of the density gradient between the intact parenchyma and the tumor in various phases of CT angiography, which, in turn, depended on the dynamics and degree of contrast of the tumor.

Tumors up to 4 cm caused by RCC with hypervascularization, regardless of their location, in 83% of cases were characterized by intense, uniform contrast with maximum peak contrast in the corticomedullary (CMF), nephrographic phases (NF) and had a homogeneous structure on ultrasound and CT.

Tumors larger than 6 cm had a heterogeneous structure due to necrosis and hemorrhages. They were characterized by heterogeneous contrast enhancement and a predominantly peripheral type of blood flow. The same type of blood flow was typical for nephroblastomas. The best conditions for identifying kidney tumors were created in the NF. In this phase, the maximum density gradient was established between the intact parenchyma and the tumor with hyper-, hypo- and avascularization.

The early excretory phase made it possible to visualize the volumetric effect of the tumor on the pyelocaliceal system. Taking into account the high frequency of asymptomatic malignant neoplasms of small (up to 40 mm) sizes, there is a need to develop an algorithm for radiation screening of patients, taking into account the analysis of concomitant diseases. Based on an analysis of the algorithms for complex radiological diagnosis of renal tumors available in the literature [6, 11, 13] and our own results of radiological examination of retroperitoneal tumors from 2000 to 2009, we developed an algorithm for the diagnosis of renal tumors (see Fig. 1).

Rice. 1. Algorithm for diagnosing kidney tumors

Modern ultrasound technologies (ultrasound, ultrasound with colorectal dosage, ED) make it possible to establish the presence or absence of a kidney tumor, study its structure and the nature of blood flow. The structure of the neoplasm (echo density) can be isoechoic (corresponding to the density of the kidney parenchyma), hyperechoic (density close to the characteristics of the renal sinus), hypoechoic (corresponding to the liquid contents), mixed (a combination of isoechoic with hypo- and anechoic areas).

Kidney cancer is characterized by an iso- or hyperechoic structure of the tumor. The pronounced hyperechogenicity of the tumor is often a manifestation of the high fat content in the tumor and is more characteristic of an angiolipoma or lipoma. The hypoechogenicity of the determined structure in the kidney may correspond to the non-tumor nature of the neoplasm (xanthogranulomatous pyelonephritis, ischemic area, carbuncle, abscess). A kidney neoplasm of a mixed structure can be represented by kidney cancer with an area of ​​necrosis and hemorrhage, multilocular cystic nephroma with thick septa, unilacunar cyst, cystic form of kidney cancer, kidney cancer in a cyst.

However, all of the listed characteristics do not have morphological specificity. Kidney cancer can be not only iso-, hypo-, but also hyperechoic, which fully applies to the ultrasound characteristics of neoplasms of a different morphostructure. The presented characteristics are necessary to orient the radiology specialist not regarding a possible diagnosis, but to clarify the examination program. The answers to these questions are provided by CT with intravenous contrast enhancement through bolus administration of a contrast agent or multislice computed tomography.

The assumption that the neoplasm is benign in case of choosing expectant management must be confirmed by the results of fine-needle aspiration biopsy under ultrasound control. In patients with clinical manifestations of a renal tumor (hematuria, low back pain, palpable mass), stage III-IV RCC is often detected.

The complex radiation examination algorithm we developed made it possible to identify kidney space-occupying lesions in 95.0±3.5% of cases and to establish their nature in 90.0±1.5%. Morphological verification of tumor tissue before surgery is one of the criteria for choosing treatment tactics. Before surgery, a pharmaco-ultrasound study is performed to assess the functional state of the kidneys with intravenous administration of furosemide. Significant dilatation of the collecting system that persists for up to 35 minutes indicates obstruction of the urinary tract. Functional failure of the contralateral kidney indicates the need for organ-preserving surgery on the affected kidney.

Of 117 patients with solitary cysts and polycystic kidney disease, gray scale ultrasound revealed atypical “cystic masses” and “fluid formations” in 19 (14.5%). These patients underwent ultrasound with color circulation and multiphase CT angiography. Scanning was performed in the native phase (NatP), in the corticomedullary phase (CMF), nephrographic phase (NF), in the early excretory phase (ERP, at 25 s, 120 s and 7 minutes from the start of administration of 100 ml of ultravist ). Of 119 patients with RCC, cystic forms of RCC were diagnosed in 19 (15.8%), cystic forms of nephroblastoma - in 13, nephroblastoma with necrosis, hemorrhage, cyst formation - in 16 children aged 7-12 years. They were sent for RCT after ultrasound in a gray scale mode with a diagnosis of “massive fluid formations of the kidneys.”

With the increase in the size of adenocarcinomas and nephroblastomas (more than 9x6 cm), the frequency of tumors with a heterogeneous solid-cystic structure has increased due to necrosis, hemorrhage, cystic masses caused by the peripheral type of neoangiogenesis (areas of necrosis, hemorrhage, cystic masses do not accumulate contrast agent, and with ultrasound CDC blood flow is visualized only in the periphery - in areas of solid structure). Of the 19 cystic forms of neoplasms identified among 117 patients with solitary cysts and polycystic disease, 6 (31.7%) had a multilocular structure, 13 had a unilocular structure, more clearly visualized in NatF RCT.

For a multilocular cyst, a characteristic RCT sign was the presence of a cavity formation measuring more than 4 cm with the presence of a common capsule and multiple daughter cysts of various sizes containing fluid with a density of 12 to 25 units. HU. The common capsule was clearly visualized. Sharp local thickening of the capsule walls, heterogeneity of the walls and septa, the presence of a soft tissue component inside the cystic formation were detected in 2 of 6 multilocular cysts with contrasting in CFM, NF, REF (category IV according to M.A. Bosniak) - cystic form of RCC.

In 11 out of 13 unilocular cysts, RCT revealed uneven thickening of the walls (5-7 mm), heterogeneous contents, the presence of a soft tissue component inside the cyst in NatF with accumulation of contrast agent in the CMF, NF, REF (category IV according to M.A. Bosniak). One patient had a “cystic mass” of more than 6 cm in the right kidney with accumulation of contrast agent in the CMF, NF, REF in the soft tissue component and a formation with a diameter of 2 cm in the left kidney, which did not accumulate contrast agent. Ultrasound-guided puncture biopsy revealed cancer cells (avascular form of RCC).

Complicated hemorrhagic cysts were diagnosed in 6 patients. On CT scans, their density in NatP exceeded 50 units. HU, but they did not accumulate contrast agent (category II according to M.A. Bosniak). Hemorrhagic cysts were characterized by thickened walls, increased echogenicity on ultrasound, and increased density on CT.

In 5 cases, atypical angiomyolipomas were identified, which, due to the presence of cysts and hemorrhages in their structure, created a picture similar to the cystic form of RCC. Differential diagnosis of a renal mass detected by ultrasound in a gray scale mode includes a benign cyst (simple, complex), angiomyolipoma, lymphoma, metastasis, “small” RCC, adenoma, oncocytoma, hematoma, “cold abscess”, carbuncle, nodular xanthogranuloma.

Cysts suspicious for malignancy are classified by radiologists as complex if the following criteria are met: low-density mass with septations, calcification, nodule, wall indistinctness; a high-density lesion on a native CT scan, a low-density or high-density lesion that indirectly accumulates contrast agent [3, 4]. As the size of RCC increases, the ratio of its elements changes due to hemorrhages, necrosis, and cyst formation.

We considered the pathological process in the kidney as a simple cyst if ultrasound revealed an anechoic formation with enhancement of the far wall, and CT, if it was sufficiently distinct and homogeneous, visualized the capsule and its density was in the range of 5-15 units. HU. The presence of pronounced contours in combination with homogeneity and high density (higher than the density of renal parenchyma in NatF on CT), the lack of contrast, made it possible to classify such a formation as a hyperdense cyst.

Tumors that, according to ultrasound and ultrasound with colorectal dosage, X-ray computed tomography with multiphase contrast, contained cystic components, but were not simple cysts, were considered complex. Other formations were classified as non-fatty (lipomas, PAML) solid masses when their density was higher than that of the liquid in NatF at CT, and in CMF, NF, REF they demonstrated an accumulation of contrast agent of more than 10-20 units. HU—hypervascular forms of RCC, confirmed by fine-needle aspiration biopsy (FNA).

The nature of the change in the density of the pathological focus after intravenous administration of a contrast agent is an extremely important feature in distinguishing between atypical cysts and tumors. Malignant tumors, due to their cystic-necrotic nature, do not accumulate contrast material, which is consistent with the data of NS Curry (1995). In 5% of cases, malignant tumors of a solid, solid-cystic nature are avascular. FNA is of primary importance in their diagnosis.

Some cysts are complicated by bleeding, infection, or hemorrhage. In these cysts, CT visualizes septa and calcification in the walls. They have a high density (40-60 HU units) in NatP QDs. The noted features make it difficult to differentiate them from malignant tumors. According to our data, in CMF, NF, and REF there is no accumulation of contrast agent, which allows us to exclude the cystic form of RCC. Extensive hemorrhage can also occur in cystic forms of RCC, and then they have a similar picture to hemorrhagic cysts. In NatF Kt, the average density of cysts is 10 units. HU (t 13 HU units). The increase in the density of cysts in the CMF is 1 unit. HU, maximum increase - 6 units. HU, in NF - 3 units. HU (maximum - 9 HU units), which is consistent with the results of studies [15].

A complete analysis of CT characteristics includes features of the CT picture in NatF, the presence and localization of calcifications, the presence and thickness of the walls and septa of the cyst, the number of septa, their local thickening, and the presence of soft tissue components in the cyst.

The greatest difficulties in terms of differential diagnosis are caused by atypical renal cysts. Cellular (“chocolate cysts”) and hemorrhagic cysts on ultrasound and CT give a picture similar to tumors. At the same time, cystic forms of RCC, tumors with decay cavities and hemorrhages are difficult to distinguish from cellular cysts. We have not received clear data on the morphovariants of cystic RCC (cancer in a cyst, cystic transformation of RCC). There are no clear criteria for differentiating cysts of categories II and III according to M.A. Bosniak. Cystic forms of Wilms tumor were detected by ultrasound as cystic formations of various sizes with thickened (5-7 mm) walls, heterogeneous contents and soft tissue components. In this regard, there is a need to carry out ultrasound-guided FNA, which makes it possible to establish a morphological diagnosis in 82±3.4%.

Thus, the most highly informative method in the differential diagnosis of cystic forms of RCC, atypical cysts, tumors with necrosis, hemorrhage and cyst formation is multiphase CT angiography, performed in combination with ultrasound-guided FNA, which is consistent with the data of the authors [14, 15].

The following variants of cystic forms of RCC have been identified depending on macroscopic signs:

1. Internal multilocular cystic growth is stated in cases where there are multiple non-connecting cystic cavities inside the cavity. The formation, as a rule, has a well-defined pseudocapsule; blood is often present in the cavities, and neoplastic cells are present in the septa.

2. Internal unilocular cystic growth - the tumor is predominantly a fluid mass with a thick wall. Microscopically, the inner layer of this mass consists of epithelial neoplastic cells. Hemorrhages into the cyst cavity are often detected.

3. Cystic necrosis is the result of massive necrosis and hemorrhage, and the mass can be either uni- or multilocular. However, along with the massive fluid component, there are large tissue areas in which microscopy reveals neoplastic cells.

S.S. Shlykov, R.F. Akberov, E.V. Puzakin

Kazan State Medical Academy

Republican Clinical Hospital No. 2 of the Ministry of Health of the Republic of Tajikistan

Shlykov Stanislav Sergeevich - applicant for the Department of Radiation Diagnostics

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2. Alyaev Yu.G., Krapivin A.A., Grigoriev N.A. Features of diagnosis of kidney tumors up to 4 cm // Med. visual., 2003. - No. 2. - P. 33-39.

3. Alyaev Yu.G., Krapivin A.A. Kidney resection for cancer. - M.: Medicine, 2001. - 224 p.

4. Gromov A.I. Diagnostic approach to incidentally detected small pathological formations in the kidneys / Modern radiodiagnosis in a multidisciplinary medical institution. - St. Petersburg, 2004. - pp. 87-88.

5. Kurzantseva O.M. Refined radiodiagnosis of cystic formations of the kidneys: Abstract of thesis. diss. ...cand. honey. Sci. - M., 2002. - 22 p.

6. Trapeznikov N.N., Poddubnaya I.V. (ed.) Handbook of Oncology. - M.: KAPPA, 1996. - P. 150-152.

7. Trapeznikova M.F., Glybin P.A., Morozov A.P. and others. Angiogenic factors in renal cell cancer // Oncourology, 2008. - No. 4. - P. 82-87.

8. Bosniak MA The current radiological approach to renal cyst // Radiology, 1986. - Vol. 158. - P. 1-10.

9. Cloix P., Martin X., Pangaud C. Surgical management of complex renal cyst: a series of 32 cases // J. Urol., 1996. - Vol. 156. - P. 28-30.

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How does carcinoma manifest?

Carcinoma has uneven outlines without the presence of capsules, which is a sign of a negative mass structure. Often a pseudocapsule is visualized, which is formed by compressed parenchyma around the cancer tumor. As the cancer grows, it extends beyond the silhouette of the kidney.

White spots with smooth round shapes without a malignant inclusion indicate the presence of sand or stones, and shadowy paths indicate the presence of gases or accumulation of calcium salts.

What else can ultrasound images record?

A dark highlight near the kidneys, which has regular contours, is a possible consequence of hemorrhage, which indicates an anechoic formation in the kidney parenchyma. When bleeding occurs, the area becomes larger. When blood clots, the neoplasm does not reflect the sound wave.

Dark outlines may be a sign of a prolonged inflammatory process, which is accompanied by the accumulation of pus.

This can lead to complications such as:

• cyst rupture with extensive bleeding;
• compression of the kidney parenchyma, which impairs the functionality of the organ;
• nephropathy.

Carcinoma (malignant cyst)

Ovarian carcinoma or malignant cyst is quite rare. There is an increased likelihood of developing ovarian cancer in women whose relatives had ovarian or breast cancer, as well as in patients who have never given birth. Symptoms of a malignant ovarian cyst are as follows:

• weakness;
• pain in the lower abdomen;
• headache;
• weight loss.

Ovarian carcinoma is treated only with surgery. After removal of the tumor, drugs that destroy cancer cells (chemotherapy), as well as irradiation of the ovaries (radiotherapy), may be prescribed.

anechoic formation in the ovary, cyst

Complications

Often, an anechoic formation in the renal sinus can provoke serious complications. The anomaly can become a trigger for the development of an infectious process, which is accompanied by fever, rise in temperature and increased pain.

Cyst rupture may also occur, which is accompanied by acute pain in the back or side. There is a violation of urination, which leads to swelling of the kidney (hydronephrosis).

The presence of multiple cysts is fraught with serious complications. Polycystic disease can provoke partial or complete atrophy of the organ, which leads to kidney failure.

Diagnostic methods

To identify a pathology such as an anechoic formation in the kidney, the following methods are used:

• ultrasound examination with the use of diuretics;
• Doppler ultrasound of renal vessels;
• nephroscintigraphy;
• computed tomography using contrast rays;
• blood and urine tests;
• taking cells for culture (cytological examination is carried out in exceptional cases).

Comprehensive diagnosis is a guarantee of correct therapy. An achenogenic formation detected by ultrasound must be differentiated from a malignant tumor or cystic cell carcinoma of the kidney.

Treatment of achenogenic inclusions

Most cystic formations that are not accompanied by changes in tissue structure and do not cause hemorrhage or difficulty urinating do not require special treatment. However, the infectious process requires careful monitoring by specialists. For this purpose, it is recommended to undergo an ultrasound examination and blood and urine tests twice a year.

If the neoplasm provokes complications such as various types of pyelonephritis, kidney stones, or increased blood pressure, then the patient is prescribed immediate treatment.

How is an anechoic formation in the kidney eliminated? Treatment is carried out depending on the size and extent of the inflammatory process. A specialist may suggest removing the contents of the cyst through puncture followed by drainage. In some cases, surgical intervention is resorted to.

Laparoscopy has a high level of effectiveness. Removal of the cyst requires subsequent medical treatment, as well as taking vitamins and minerals that have an antibacterial effect and strengthen the immune system. The function of the kidneys and blood vessels is also normalized.

The earlier therapy was started, the sooner recovery will occur.

Kidney cyst - symptoms and treatment

A simple renal cyst is a single benign fluid formation that is one of the most common urological diseases.

Simple renal cyst occurs in 10% of people in the general population [4]. Due to the widespread use of modern medical imaging methods (ultrasound, MRI, MSCT), the frequency of detection of this pathology is increasing every year [1][2][3][8].

The kidney is one of the most common places for the formation of cysts, and the urinary system of our body ranks first in the number of development of various anomalies [1][2][3]. Cystic lesions are the most common type of renal structure abnormality, and simple cysts are the most common type of cystic lesion. Simple kidney cysts are more often diagnosed in men; the frequency of their occurrence increases with age. Renal cysts (single or multiple) are observed in 50% of people over 50 years of age [4][8].

A congenital simple renal cyst occurs as a result of an abnormal development of the renal tubules, which lose communication with the urinary tract. The hereditary mechanisms responsible for the formation of kidney cysts during intrauterine development of the fetus remain unclear. A congenital simple renal cyst can appear either as a result of the inheritance of certain genes (genetic diseases) or due to a mutation during embryo development (in the period from 32 to 50 days from the moment of conception). These mechanisms are not mutually exclusive and in some cases may work together.

In addition to simple renal cysts, there are many different congenital cystic kidney anomalies: polycystic, multicystic, solitary cyst, multilocular cyst, spongy kidney, calyceal diverticulum in the upper pole of the kidney. These diseases differ not only in the type of inheritance, but also in the clinical and pathomorphological picture. Diseases such as polycystic disease (polycystic disease) and multicystic disease have significant differences from simple cysts. For example, a multicystic kidney is formed when embryogenesis is disrupted at 4-6 weeks and is characterized by total replacement of the renal parenchyma with cysts of different sizes [15].

In the embryonic period, dermoid cysts can also form in the kidneys, which are sometimes similar to congenital simple cysts. A renal dermoid cyst is a cavity formation of germinal tissue. This is a very rare pathology that is formed as a result of a chromosomal malfunction and disruption of normal cellular differentiation and development of the embryo. Unlike a simple cyst, they contain the rudiments of adipose tissue, teeth, hair, etc. Dermoid cysts should cause serious oncological suspicion among both doctors and patients. In 5-8% of cases, malignancy (cancerous degeneration) of the dermoid cyst occurs. Some of its cells can eventually turn into a source of tumor growth. This happens under the influence of internal or external irritating factors. Such cysts require surgical treatment [1][2][3][6].

An acquired renal cyst can be the outcome of various diseases occurring in the kidneys, such as urolithiasis, chronic pyelonephritis, various kidney tumors [1][2][3][6]. One of the reasons for the formation of kidney cysts may be damage to the organ by parasites (echinococcus, alveococcus). For example, hydatid cysts of the kidney (caused by Echinococcus granulosus) occur in 2-3% of all kidney cysts. The larva of echinococcus is carried by the bloodstream into the kidney from the liver, so first of all it is necessary to exclude the presence of a large parasitic formation in the liver.

Multiple kidney cysts occur in patients who suffer from chronic kidney disease and have been on hemodialysis for many years. It is known that kidney cysts occur in 50% of patients undergoing dialysis for more than 10 years. At risk are patients with a transplanted kidney, end-stage chronic renal failure, Hippel-Lindau disease (a rare genetic disease characterized by the development of various tumors and cysts in the central nervous system and other internal organs) [1][2][3][ 6][12]. Also, numerous other reasons contributing to the formation of kidney cysts include: hereditary predisposition, previous diseases, traumatic kidney damage, frequent hypothermia [1][2][3][6][12].