A 49 year old woman falls off her bike, she is stable and has an abrasion along her right flank. You can feel a mass in the RUQ and perform an EFAST scan.
Describe and interpret these scans
Image 1: A RUQ FAST view showing the kidney, Morrison’s pouch and the lower part of the right lobe of the liver.
The kidney is markedly enlarged and there are multiple anechoic cystic structures of varying size throughout the right kidney. Numerous cysts are also seen in the liver parenchyma. No free fluid is evident in this view. This is the typical appearance of the kidneys of a patient with polycystic kidney disease.
Polycystic kidney disease
Autosomal dominant polycystic kidney disease (ADPKD) has an incidence quoted between 1:200 and 1:2000. From an ultrasound perspective cysts are seen in the kidneys in increasing numbers with increasing age. Patients often become symptomatic in their 4th and 5th decades, and 50% require dialysis by age 60.
Sonographic diagnostic criteria for ADPKD1 for at-risk patients (family history of ADPKD) include: At least 2 cysts in 1 kidney or 1 cyst in each kidney in an at-risk patient younger than 30 years. At least 2 cysts in each kidney in an at-risk patient aged 30-59 years. At least 4 cysts in each kidney for an at-risk patient aged 60 years or older
Cysts can also be seen in the liver, pancreas, spleen, ovaries and lungs. Cerebral aneurysms and mitral valve prolapse are other known associations.