Triple contrast percutaneous nephrocystography and analysis of cyst aspirate

Accumulated experience with triple contrast percutaneous nephrocystography (water-soluble contrast, iophendylate [Pantopaque], and air) in 42 patients with avascular lesions is presented. Diagnostic studies were accomplished in 40 with surgical correlation in 11. Of the 35 patients with intracystic iophendylate, progressive cyst shrinkage was observed in the 29 with adequate x-ray follow up. The reduction in cyst size was attributed to a marked reactive inflammatory proliferative response with fibrosis of the cyst wall which was found in 6 patients after introduction of iophendylate when compared with a control group of 13 others with surgically proved cysts. Intracystic iophendylate may be especially therapeutic in the nonsurgical management of renal cysts associated with pain, calyceal obstruction, and hypertension. The cyst aspirate was analyzed for appearance, culture, cytology, fat content, and multichannel chemistries (SMA). The index accuracy of these combined tests is high although instances of false positives and negatives for tumor are stressed. The nonsurgical diagnosis of renal cystic lesions is incomplete without percutaneous cyst puncture, contrast study, and analysis of cyst aspirate.