Multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney: CT and MRI findings and clinical characteristic

• Published in: European radiology 2019-09, Vol.29 (9), p.4843-4850
• Main Authors: Yoshida, Kotaro, Takahashi, Naoki, King, Bernard F., Kawashima, Akira, Harris, Peter C., Cornell, Lynn D., Cornec-Le Gall, Emilie, Inoue, Dai, Mizushima, Ichiro, Kawano, Mitsuhiro, Thervet, Eric, de Cotret, Paul René, Torres, Vicente E.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - etiology; Adult; Attenuation; Computed tomography; Cysts; Diagnostic Radiology; Family medical history; Female; Genetics; Hematuria; Hematuria - etiology; Hemorrhage; Hemorrhage - diagnosis; Hemorrhage - etiology; Humans; IgA nephropathy; Imaging; Immunoglobulin A; Internal Medicine; Interventional Radiology; Kidney Cortex; Kidney Diseases, Cystic - diagnosis; Kidney Neoplasms - diagnosis; Kidneys; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Multidetector Computed Tomography; Neuroimaging; Neuroradiology; Pain; Patients; Radiology; Renal cortex; Renal function; Retrospective Studies; Signs and symptoms; Ultrasound; Urogenital; Viscera
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06057-3

Purpose The aim of this study was to clarify the radiologic and clinical characteristics of multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney. Method Fourteen patients with unique and characteristic multiple hemorrhagic subcapsular cortical cysts of the kidney, not categorized in any existing renal cystic diseases, were retrospectively reviewed. The clinical information including age, sex, symptom, family history of renal or renal cystic disease, and laboratory data were collected. CT and MRI findings including distribution, number and size of cysts, and CT attenuation and signal intensity on T1- and T2-weighted MRI of cysts were analyzed. Results All patients except one were young and none had a family history of renal or renal cystic disease. Common clinical symptoms were flank or abdominal pain and hematuria. In all cases, only the left kidney was involved at initial presentation. Cysts were small (median cyst size, 4–15 mm), numerous, and distributed mainly along the subcapsular cortex of the kidney. Cysts were hyper-attenuated on unenhanced CT, extremely hypointense on T2-weighted MRI, and mildly hyperintense on T1-weighted MRI. All patients except one had normal renal function. Imaging follow-up revealed stable or mildly progressive disease in seven patients. Two patients developed several hemorrhagic subcapsular cortical cysts in the right kidney at follow-up. Three of five patients with a renal pathology specimen showed concurrent IgA nephropathy. Conclusion We have identified a unique renal cystic disease with multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney that has a characteristic manifestation both radiologically and clinically. Key Points • Multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney is a unique non-familial renal cystic disease with a characteristic manifestation both radiologically and clinically. • Most cases of multiple unilateral subcapsular cortical hemorrhagic cystic disease of the kidney are stable or slowly progressive, and do not require invasive intervention.