A 54-year-old man comes to the emergency department with cramping lower abdominal pain, mild nausea, and 2 episodes of watery diarrhea. The patient has no fever, vomiting, or urinary symptoms. His past medical history is unremarkable. The patient's father died at age 60 from abdominal aortic aneurysm rupture. He is a lifetime nonsmoker. His vital signs are normal. CT scan of the abdomen with contrast is shown in the image below: All gastrointestinal symptoms resolve in 2 hours without any intervention, and the patient wants to go home. Which of the following is the most appropriate management for the renal findings on the CT scan?

Question

A 54-year-old man comes to the emergency department with cramping lower abdominal pain, mild nausea, and 2 episodes of watery diarrhea.  The patient has no fever, vomiting, or urinary symptoms.  His past medical history is unremarkable.  The patient's father died at age 60 from abdominal aortic aneurysm rupture.  He is a lifetime nonsmoker.  His vital signs are normal.  CT scan of the abdomen with contrast is shown in the image below:  All gastrointestinal symptoms resolve in 2 hours without any intervention, and the patient wants to go home.  Which of the following is the most appropriate management for the renal findings on the CT scan?

Quizplus · Accepted Answer

11ec25c8_d825_4289_bc81_81a3040d9cb1_MD0003_00 This patient's CT scan of the abdomen shows a simple renal cyst on the inferior aspect of the right kidney. Such cysts are most commonly seen in patients age >50. They are benign and often discovered incidentally by radiological examination. Most of the time, cysts do not cause hypertension, flank pain, hematuria, or proteinuria; infection occurs rarely. When a renal cyst is found on imaging, it is often possible to differentiate between a simple cyst and a malignant cystic mass based on the radiological features. Features suggesting malignancy include irregular or multilocular structure with multiple septations, heterogeneous content, and contrast enhancement on CT scan or MRI. Incidentally discovered cysts with benign features require no additional follow-up evaluation or imaging, and the patient may be reassured. malignancy (Choice A) Antibiotics are not indicated because there is no evidence of bacterial infection (either gastrointestinal or genitourinary). (Choice B) Percutaneous aspiration of the cyst is not indicated because the patient has no symptoms from it. Percutaneous aspiration may be considered if the cyst is large and painful or infected with purulent material. (Choice D) Surgical excision or nephrectomy is not indicated, as this patient has a simple benign cyst with good prognosis. (Choice E) Ureteral stent placement is indicated when there is urinary obstruction at the ureter or renal pelvis. Dilation of the renal pelvis (hydronephrosis) or ureter (hydroureter) is a typical sign of urinary obstruction. This patient has no symptoms of urinary obstruction or radiological signs of obstruction on CT scan. (hydronephrosis Educational objective: Simple renal cysts are almost always benign and do not require further evaluation. Features concerning for malignant renal mass include a multilocular mass, irregular walls, thickened septa, and contrast enhancement. References: A clinical view of simple and complex renal cysts. (http://www.ncbi.nlm.nih.gov/pubmed/18776117)

A 54-Year-Old Man Comes to the Emergency Department with Cramping