Thank you Aarthi.. The answer is like this .. With an increasing use of CT scan, there has been an increase in the detection of incidental masses in the kidney. When a mass is detected incidentally, the surgeon is faced with the question as to whether the mass should be treated or whether it can be left alone. To this effect, the Bosniak classification was devised. Based upon the Hounsfield unit attenuation scale, simple cysts are expected to have HU near zero. The intent is to know whether the lesion is malignant or not. Also, if you can characterise the lesion based on the Bosniak classification, you can also predict the risk of the lesion turning malignant in the future. First, an unenhanced or plain CT scan is taken. Then, a contrast is given intravenously and we see whether the lesion enhances or not in the cortical medullary or nephrogenic phases. If it enhances, the number of HU by which it enhances is noted. If it enhances by 15-20 HU, it confirms the presence of a solid enhancing mass, usually renal cancer. Angiomyolipoma on the other hand, because of its fat content enhances less than 10 HU. It also has a typical CT image (because of the fat content) and therefore poses no diagnostic dilemma. So, an angimyolipoma is reported as such and no Bosniak grade is assigned to it.
Sir,We had a question in recent inicet. A 45 yr old male presented with vague abdominal pain. On USG he was found to have a grade 3 bosniak renal cyst. CECT was done and shown below. Diagnosis? This was the question. And the answer was said to be angiomyolipoma. That's why a asked if there's any relation between angiomyolipoma and renal cysts.
Are you sure you’ve got the question and the options correctly? This is what radiopaedia says about the diagnosis of renal angiomyolipoma: The cornerstone of diagnosis on all modalities is the demonstration of macroscopic fat, however in the setting of hemorrhage, or when lesions happen to contain little fat, it may be difficult to distinguish an angiomyolipoma from a renal cell carcinoma. In tuberous sclerosis, the lesions are larger than isolated AML and often multiple and bilateral. Under the heading of CT scan, it further says : Most lesions involve the cortex and demonstrate macroscopic fat (less than -20 HU). When small, volume averaging may make differentiation from a small cyst difficult. It is essential to remember that rarely renal cell carcinomas (RCC) may have macroscopic fat components and as such the presence of fat is strongly indicative of an angiomyolipoma, but not pathognomonic. It is important to realize that ~5% of angiomyolipomas are fat-poor. This is especially the case in the setting of tuberous sclerosis, where up to a third do not demonstrate macroscopic fat on CT. Absence of ossification/calcification on imaging is in favor of angiomyolipoma. What I had earlier quoted to you was from Campbell, which is the standard book used by MCh students. I’m unable to find any reference to what you’ve asked. However, my advice to you would be to not go into the specifics of the questions and options asked in a previous exam. Because they may or may not repeat the same question. And you’ll end up wasting precious time. On the other hand, if you know the topic well (in this case, Bosniak classification) rest assured that you’ll be able to answer correctly, any future questions asked from that topic. All the best for NEET-PG.. :-)
Hello Sir My father have a cyst in both kidneys and liver cyst. Bosniak 2F type.......In kidney.....what should we do??plz suggest...I have alredy AIIMS CT Scan....Can i saw u??
Hallo Dr i am venkatesh i have problem in my left kidney medullary cyst 19*16mm seen in mid pole please give me remittance for to cure kidney cyst pls give me mail I'd I will send report to you
Amazing lecture thank doctor 👏
A million thanks for your very clear and wonderful explanations.
Thank you so much !🙏🏻
Awesomely explained sir👌
I have just been diagnosed with a kidney cyst from my urologist can it give you groin pain and back ache
Sir, nice explanation.
Is there any recent addition to bosniak classification?
Like angiomyolipoma?
Thank you Aarthi.. The answer is like this ..
With an increasing use of CT scan, there has been an increase in the detection of incidental masses in the kidney. When a mass is detected incidentally, the surgeon is faced with the question as to whether the mass should be treated or whether it can be left alone. To this effect, the Bosniak classification was devised. Based upon the Hounsfield unit attenuation scale, simple cysts are expected to have HU near zero. The intent is to know whether the lesion is malignant or not. Also, if you can characterise the lesion based on the Bosniak classification, you can also predict the risk of the lesion turning malignant in the future.
First, an unenhanced or plain CT scan is taken. Then, a contrast is given intravenously and we see whether the lesion enhances or not in the cortical medullary or nephrogenic phases. If it enhances, the number of HU by which it enhances is noted. If it enhances by 15-20 HU, it confirms the presence of a solid enhancing mass, usually renal cancer.
Angiomyolipoma on the other hand, because of its fat content enhances less than 10 HU. It also has a typical CT image (because of the fat content) and therefore poses no diagnostic dilemma. So, an angimyolipoma is reported as such and no Bosniak grade is assigned to it.
@@surgeonsburrow thank you sir
Sir,We had a question in recent inicet. A 45 yr old male presented with vague abdominal pain. On USG he was found to have a grade 3 bosniak renal cyst. CECT was done and shown below. Diagnosis?
This was the question. And the answer was said to be angiomyolipoma. That's why a asked if there's any relation between angiomyolipoma and renal cysts.
Are you sure you’ve got the question and the options correctly?
This is what radiopaedia says about the diagnosis of renal angiomyolipoma:
The cornerstone of diagnosis on all modalities is the demonstration of macroscopic fat, however in the setting of hemorrhage, or when lesions happen to contain little fat, it may be difficult to distinguish an angiomyolipoma from a renal cell carcinoma.
In tuberous sclerosis, the lesions are larger than isolated AML and often multiple and bilateral.
Under the heading of CT scan, it further says :
Most lesions involve the cortex and demonstrate macroscopic fat (less than -20 HU). When small, volume averaging may make differentiation from a small cyst difficult. It is essential to remember that rarely renal cell carcinomas (RCC) may have macroscopic fat components and as such the presence of fat is strongly indicative of an angiomyolipoma, but not pathognomonic.
It is important to realize that ~5% of angiomyolipomas are fat-poor. This is especially the case in the setting of tuberous sclerosis, where up to a third do not demonstrate macroscopic fat on CT. Absence of ossification/calcification on imaging is in favor of angiomyolipoma.
What I had earlier quoted to you was from Campbell, which is the standard book used by MCh students.
I’m unable to find any reference to what you’ve asked.
However, my advice to you would be to not go into the specifics of the questions and options asked in a previous exam. Because they may or may not repeat the same question. And you’ll end up wasting precious time. On the other hand, if you know the topic well (in this case, Bosniak classification) rest assured that you’ll be able to answer correctly, any future questions asked from that topic.
All the best for NEET-PG.. :-)
I’ll look up further into this.. if I get any more info, I’ll share it with you.
BOSNIA BOSNIA BOSNIA ⚜⚜⚜
Hello Sir My father have a cyst in both kidneys and liver cyst. Bosniak 2F type.......In kidney.....what should we do??plz suggest...I have alredy AIIMS CT Scan....Can i saw u??
Online consultation is difficult.. please consult a urologist
Hallo Dr i am venkatesh i have problem in my left kidney medullary cyst 19*16mm seen in mid pole please give me remittance for to cure kidney cyst pls give me mail I'd I will send report to you