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Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography

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Hemorrhagic Renal Cyst, a Case Report.

Mary Rometti¹, Christopher Bryczkowski¹, Michael Rohinton Mirza¹

¹Rutgers Robert Wood Johnson Medical School, Department of Emergency Medicine, New Brunswick, NJ.

Journal of Education & Teaching in Emergency Medicine

|July 19, 2023

Summary

A patient with a history of kidney issues presented with hematuria and signs of infection. Imaging revealed a hemorrhagic renal cyst, leading to antibiotic treatment and further evaluation for potential complications.

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Area of Science:

Nephrology
Urology
Radiology

Background:

Renal cysts are common, with simple cysts often being benign incidental findings.
Complex renal cysts can present with hemorrhage or infection, requiring further investigation.
Differentiating between simple, complex, hemorrhagic, and infected renal cysts is crucial for appropriate management.

Purpose of the Study:

To present a case of acute on chronic kidney injury with a suspected infected hemorrhagic renal cyst.
To highlight the diagnostic utility of bedside ultrasound (POCUS) and CT in evaluating renal abnormalities.
To discuss the management of complex renal cysts and associated urinary tract infections.

Main Methods:

A 73-year-old male with acute on chronic kidney injury and urinary symptoms underwent urinalysis and laboratory tests.
Bedside renal ultrasound and computed tomography (CT) scan of the abdomen and pelvis were performed for imaging.
Clinical presentation, laboratory findings, and imaging results were correlated to determine diagnosis and guide treatment.

Main Results:

Urinalysis indicated infection, and labs showed elevated white blood cell count and impaired kidney function (GFR 16 mL/min).
Bedside ultrasound identified a right renal cyst with echogenic debris suggestive of hemorrhage.
CT scan confirmed a right renal cyst with perinephric stranding and a small, non-obstructing renal stone.

Conclusions:

The patient was treated with antibiotics for a presumed infected hemorrhagic renal cyst, leading to clinical improvement.
Further outpatient evaluation, including cystoscopy and repeat ultrasound, was recommended to rule out neoplasm.
This case underscores the importance of comprehensive evaluation for complex renal cysts presenting with infectious and hemorrhagic complications.