A1) Pre-operative transplant donor evaluation

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with incidental findings.
  2. Identify the spectrum of imaging findings in appropriate modalities for evaluating a patient with an incidental finding.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
Not Applicable - This module pertains to pre-transplant workup and does not involve a provisional diagnosis.
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Potential Acuity

What is your assessment of the likely acuity for this patient?

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The patient requires routine workup.

First Imaging Study

What is the first imaging study you will order?

The Organ Procurement and Transplant Network (OPTN) requires an abdominal CT, which allows for evaluation for any structural abnormalities, stones, including congenital absence of a kidney. The use of IV contrast allows for evaluation of the renal vasculature, including assessment of anatomical variants and patency, for pre-operative planning. The echocardiogram is not required. There are no findings in this case requiring further cardiac evaluation.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

This simple cyst is benign and does not require further imaging workup.
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What is your Diagnosis now that you have seen the imaging results?

This represents a Bosniak I cyst as it has water density 0-20 with thin margins. A Bosniak II cyst would also have a few thin septations and punctate calcifications. Bosniak IIF cyst have multiple septa with nodular/irregular calcifications. Bosniak III cysts also have thick walls, irregular, heterogeneous septa, measurarble enhancement, and irregular calcifications. Lastly, Bosniak IV cysts have solid, soft tissue components. Malignancy risk: Bosniak I: 0%; II: 0%; IIF: ~5%; III: ~55%; IV: ~100%.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

The patient has no immediately life-threatening condition. However, the surgical team should be notified of the cyst as it may impact the patient’s candidacy for transplant.

Assessment and Plan

Please provide your assessment and plan for this patient

This patient is a 32-year-old female presenting for donor kidney evaluation. CT with and without IV contrast revealed a large Bosniak I cyst. While this cyst is benign, it is large and the surgical team should be notified of its presence as it may affect the patient’s candidacy for renal transplant.

Lessons Learned:
- Pre-operative donor kidney transplant workup includes a chest x-ray. CT of the abdomen with and without IV contrast is also required to evaluate for renal and vascular abnormalities that may affect donor transplant candidacy and surgical approach.
- Renal cysts are categorized with the Bosniak classification. Bosniak I and II cysts are benign. Bosniak IIF, III, and IV cysts require follow-up or intervention as they may be malignant.

Socioeconomic Factors: Recipients of kidney transplants from living donors generally have improved outcomes compared to recipients of kidney transplants from deceased donors.

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