352 | Pictorial  Urology

Department of Urology, Aintree 
University Hospital, Lower Lane, 

Liverpool, L9 7AL, United Kingdom

*E-mail: nilbury@oceanfree.net

A 57-year-old man presented with a 6-month history of suprapubic pain, abdominal distension, ano-rexia, and altered bowel habit. He had no urological symptoms. Physical examination revealed a distended abdomen with shifting dullness and a benign prostate. 
Routine hematology, biochemistry, and serum tumor markers were within normal limits. Computed tomog-
raphy of his abdomen revealed bilateral simple renal cysts with the largest measuring 28 × 14 × 16 cm. 
He underwent bilateral renal cyst aspiration whereby 6 liters of fluid were removed with negative cytology. 
The patient reported rapid weight loss of 4 kg and restoration of appetite within days. Subsequent ultra-
sonography after 4 months revealed partial reaccumulation of the cysts, but the patient remained asymp-
tomatic. 
Unilateral renal cysts measuring 15 cm have been reported to cause anorexia, intermittent diarrhea, and 
intestinal obstruction, and when aspirated, have contained 1.5 liters of fluid.(1) Giant renal cysts presenting 
simply with progressive abdominal distension can lead to a misdiagnosis, such as obesity, which reverses 
following open decortication.(2) Laparoscopic decortication for renal cysts up to 25 cm remains technically 
challenging.(3) Massive renal cysts may present with gastrointestinal symptoms, which resolve promptly 
following decompression.

Michael St John Floyd Jr,* Rahul Mistry, Andrew David Baird 

Bilateral Giant Renal Cysts Masquerading
as Malignant Ascites

REFERENCES
1. Vos B, Laureys M. [Giant renal cyst as cause of colic obstruction]. Rev Med Brux. 2009;30:107-9.

2. Brown JA, Segura JW, Blute ML. A giant left renal cyst presenting as obesity: a unique presenta-
tion. Arch Esp Urol. 1998;51:105-7.

3. Mingoli A, Brachini G, Binda B, Carocci V, Tiddi C, Modini C. Laparoscopic transperitoneal decor-
tication of a giant peripelvic renal cyst. J Laparoendosc Adv Surg Tech A. 2008;18:845-7.

Pictorial  Urology