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Review Question - QID 220684

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QID 220684 (Type "220684" in App Search)
A 42-year-old man is brought to the emergency department after he was involved in a car accident. He has some chest pain but otherwise feels well. The pain is located on the right side of his chest and is worse with breathing in deeply. He denies any pain in his abdomen or extremities. He has no significant medical history and does not take any medications. He drinks 2-3 alcoholic beverages per week and does not smoke. His temperature is 98.6°F (37°C), blood pressure is 116/72 mmHg, pulse is 75/min, and respirations are 14/min. He has tenderness to palpation over the right 4th and 5th ribs. The rest of the physical exam is benign. A CT scan is obtained, and the result shown in Figure A is observed. He is also found to have 2 right-sided rib fractures. Which of the following is the most appropriate next step in management with regard to the finding seen in Figure A?
  • A

Biopsy

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Genetic testing

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Reassurance

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Serial CT scans

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Wide excision

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  • A

Select Answer to see Preferred Response

This patient who is found to have an incidental cyst in the kidney most likely has a simple renal cyst. These cysts are benign and do not require further treatment or workup.

A simple renal cyst is a benign growth on the surface of the kidney. These lesions are asymptomatic and are most commonly discovered incidentally when a scan is performed for other reasons. A simple renal cyst is a smooth, round, and non-septate mass. It is not associated with neoplastic development or underlying genetic abnormalities. In the absence of any concerning features such as septations, abdominal pain, or multiple cysts, reassurance is all that is needed.

Zhou et al. review the evidence regarding the diagnosis and treatment of simple renal cysts. They discuss how these lesions may be a risk factor for the development of hypertension. They recommend no additional treatment for these cysts.

Figure/Illustration A is a CT scan showing a small hypodense cyst in the kidney (red circle). This is consistent with a simple renal cyst that does not require further workup.

Incorrect Answers:
Answer 1: Biopsy would be the appropriate next step in management for lesions where there is a concern for malignancy. These would include complex cysts and enhancing lesions of the renal parenchyma. A simple cyst that is discovered incidentally does not require further workup or treatment.

Answer 2: Genetic testing would be the appropriate next step in management for lesions where there is a concern for an underlying genetic disorder. An example would be polycystic kidney disease, which would present with multiple cysts that can be associated with abdominal pain or renal failure. This disease can also be associated with cyst development in other organs.

Answer 4: Serial CT scans would be the appropriate next step in management for lesions where there is a concern for malignancy. For example, patients who have lung lesions in the setting of smoking can be screened with serial CT scans.

Answer 5: Wide excision is the appropriate treatment for a lesion that is confirmed to be malignant. A tissue diagnosis is needed before wide excision in most cases.

Bullet Summary:
A simple renal cyst is a smooth, round, and non-septate mass that does not require further workup or treatment.

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