Sclerotherapy of a Giant Renal Cyst with Povidone-Iodine

Abstract

We report a giant renal cyst manifested by edema of the lower limbs. The cyst was successfully treated by percutaneous sclerotherapy with povidone-iodine. CASE REPORT A 90-year-old man presented with edema of the lower limbs. History was unremarkable for cardiopathy or nephropathy. Physical examination demonstrated right abdominal distention. Digital rectal examination was normal. Abdominal ultrasound revealed a 26 18 17 cm. cystic lesion below the liver, consistent with a right renal cyst. Computerized tomography (CT) confirmed the presence of a giant renal cortical cyst with a functioning right kidney draped medially (fig. 1). Because of the age of the patient, minimally invasive therapy was planned. Percutaneous drainage of the cyst was performed under ultrasonographic guidance using a 10Fr J stent. Approximately 4,000 ml. cystic fluid was aspirated. Cystic fluid cytology was negative. On postoperative day 3 sclerotherapy of the cyst was performed. A combination of 100 ml. 10% povidone-iodine and 100 mg. doxycycline was injected into the cyst cavity, and the stent was clamped for 20 minutes and then reopened. This procedure was repeated daily for 3 days. No local or systemic adverse effects were noted. The J stent was removed on postoperative day 6 and the patient was discharged from the hospital on postoperative day 7. Two months later the edema of the lower limbs had resolved and CT showed a 70% reduction in the cyst. Repeat CT at 1, 2 and 3-year followup demonstrated complete resolution of the cyst (fig. 2).