1. Asha Sheth, MD June 25,2014

2. What is a cyst? Types of cysts Differentials Imaging appearances 3. Closed pocket or pouch of tissue It can be filled with air, fluid, pus, or other material 4. Thin /Thick walled With / Without wall calcifications Regular/ Irregular in shape Small / Large in size With / Without internal septa Thin / Thick Single / Multiple With /Without Solid component 5. HEPATOBILIARY Choledochal Cyst Gallbladder Hydrops GASTROINTESTINAL Duplication Cyst Omental/Mesenteric Cyst URINARY TRACT Renal /parapelvic Cyst Severe Hydronephrosis/Pelviureteric junction Obstuction. Cystic Wilms Tumour (rare) Urachal Cyst 6. ADRENALS Resolving adrenal heamorrhage Cystic neuroblastoma/Ganglioneuroma(rare) PANCREATIC Pancreatic pseudocyst PELVIC Ovarian Cyst Teratoma/Dermoid Cyst Anterior Meningocele Abscess 7. CHOLEDOCHAL CYST GALLBLADDER HYDROPS 8. Congenital dilatations of the biliary tree Most cause symptoms in childhood and adult life Todanis classification Type I- Fusiform TypeII- Diverticulum Type IlI- Choledochocele of intraduodenal common bile duct Type IV- Extra- and intrahepatic cysts Type V- Intrahepatic dilatations (Carolis Disease) 9. Complications include cholangitis, biliary calculi, pancreatitis and biliary cirrhosis Biliary tree dilatation or cyst can be seen on Ultrasound or CT 99mTc-HIDA scinitraphy will show accumulation of tracer within the cyst Percutanous or endoscopic cholangiography and MRCP are helpful in preoperative planning 10. Fusiform choledochal cyst with a long common channel and associated stricture at the pancreaticobiliary junction. 11. Ultrasound study shows a cystic mass between pancreatic head and the gallbladder. Smooth wall and homogeneous anechoic contents, tortuous cystic duct that joins the gall bladder to the cystic mass 12. Duplication Cyst Omental/Mesenteric Cyst 13. May occur anywhere along the gastrointestinal tract The most frequent sites of duplication are the ileum, followed by esophagus, stomach, duodenum and jejunum 1/3rd of cases involve the distal small bowel Colonic and rectal duplications are rare Etiology is incomplete recanalization around 8 weeks gestation Cysts lined with GI epithelium 14. Can be spherical or tubular Most duplications do not communicate with the adjacent bowel, although there is a higher incidence of persistent communication in tubular anomalies Presentation depends on the site of duplication and its size Incidental ultrasound finding in the first few years of life 15. Large cysts, especially those associated with the stomach or duodenum, may present with Abdominal pain Obstruction Vomiting Can serve as lead point for intussusception Be a source of gastrointestinal bleeding from ectopic gastric mucosa 16. Abdominal radiographs may show mass effect with displacement of adjacent bowel loops Ultrasound demonstrates a simple anechoic or hypoechoic cyst characteristic 'gut-wall signature' TREATMENT: Surgical resection 17. Abdominal x-ray of a patient with a duplication cyst. Note the mass effect of the cyst pressing against the areas of colon (arrows). 18. Simple cystic mass with characteristic gut wall signature 19. Gastric duplication cyst causing gastric outlet obstruction in a pediatric patient 20. Contrast-enhanced computed tomography image of the abdomen showing a well- circumscribed, low-attenuation fluid collection seen in relation to the greater curvature of the stomach with rim enhancement, suggestive of an intestinal duplication cyst 21. Developmental anomalies of the lymphatic system arising within the mesentery or omentum Presentation is similar to duplication cysts Ultrasound is more likely to show a multiloculated cyst with thin septations Require surgical resection 22. Mesenteric cyst CT demonstrating a large left-sided cystic abdominal mass with compression of the left kidney. Ultrasound showed multiple fine septations within the cyst 23. Lymphangioma has enhancing septa. Unlike in cystic peritoneal metastases, ascites is not a feature of lymphangioma. When you see a septated cystic lesion without ascites the most likely diagnosis is a lymphangioma. 24. Notice that CT does not always appreciate the septations, although the specimen clearly shows multiple septations. 25. Renal /Parapelvic Cyst Severe Hydronephrosis/UPJ obstruction Cystic Wilms Tumour (rare) Urachal Cyst 26. Severe hydronephrosis with proximal hydroureter 27. Resolving adrenal heamorrhage Cystic neuroblastoma/ Ganglioneuroma(rare) 28. commonest cause of an adrenal mass Associated with perinatal stress, hypoxia, septicaemia and hypotension may be unilateral or bilateral Adrenal insufficiency is rare, even in bilateral cases. Ultrasound in the first few days of life usually demonstrates an avascular heterogenous adrenal mass that becomes cystic and smaller over the following weeks as clot retraction 29. Over half of them arise in the adrenals, but 30% can arise from sympathetic tissue elsewhere in the abdomen Calcification has been noted to occur in over 50% of Cases Ganglioneuroma is a mature form of neurogenic tumour. Calcification helps in suggesting a diagnosis of neurogenic tumour 30. Adrenal ganglioneuroma with hepatic metastasis 31. Pancreatic pseudocyst 32. well-known complication of pancreatitis fluid collections may occur within the pancreatic mass, or in the peripancreatic spaces, or elsewhere within the abdomen following either acute / chronic pancreatitis In acute pancreatitis, the pseudocyst contains enzyme-rich fluid and products of autodegradation of the pancreas in chronic pancreatitis the cyst is a consequence of duct obstruction. 33. Patients who have persistent abdominal pain or persistently elevated levels of pancreatic enzymes should be suspected of harbouring a pseudocyst one-third of pancreatic pseudocysts will resolve spontaneously 34. Pancreatic pseudocyst Large septated cystic mass in the mid abdomen with nodular component. In the absence of history of pancreatitis it would be difficult to differentiate this from a cystic pancreatic tumour. 35. Ovarian Cyst Teratoma/Dermoid Cyst Anterior Meningocele Abscess 36. Cysts are fluid filled spaces within the ovary. very common and could be physiological / pathological, benign/ malignant Functional or physiological cysts are either follicular or of corpus luteum origin. Follicular cysts form when a follicle fails to rupture at midcycle leading to its continuous enlargement. Usually these cysts are asymptomatic and disappear without any intervention within one or two months Similarly a persistent corpus luteum might fail to disintegrate before menstruation and enlarge in size 37. Both follicular and luteal cysts could become haemorrhagic if bleeding occured within them leading to rapid increase in size and severe pain. they might cause severe pain only if they are large in size (>7 cm) and cause pressure symptoms or torsion of the whole ovary compromising blood flow when surgical intervention is indicated 38. A simple ovarian cyst on the right side of the uterus 39. Haemorrhagic ovarian cyst 40. A teratoma is an encapsulated tumor with tissue or organ components resembling normal derivatives of more than one germ layer They therefore contain developmentally mature skin complete with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. 41. A pus-filled cavity in the pelvis due to infection A pelvic abscess is the end stage in the progression of a genital tract infection and is frequently an unnecessary complication Treatment : Surgical drainage of abscess and dead tissue removal/ antibiotics 42. Abdominal computed tomography showed pelvic abscess (asterisk) and right tubo- ovarian abscess (arrow). 43. Cysts may have different characteristics and origins Location, appearances, multi modality can help in the diagnosis