CPT® Code 74470

1. Indications

The renal cyst study using a translumbar approach is indicated for the evaluation of renal cysts that may exhibit characteristics suggestive of malignancy. This procedure is typically performed when there is a need to assess the nature of a renal cyst, particularly when there are concerns regarding its size, shape, or other features that may indicate a potential risk for cancer. The following conditions may warrant this examination:

• Suspicion of Malignancy The procedure is indicated when imaging studies suggest that a renal cyst may have malignant features.
• Characterization of Renal Cysts It is performed to obtain detailed information about the cyst's characteristics, such as its size, shape, and internal structure.
• Monitoring Known Cysts The study may be indicated for monitoring previously identified renal cysts that have changed in appearance or size over time.

2. Procedure

The renal cyst study involves several key procedural steps that ensure accurate visualization and assessment of the cyst. The following steps outline the process:

• Step 1: Patient Preparation The patient is positioned appropriately, typically lying on their back, to allow access to the lower back region. The area of the skin where the needle will be inserted is cleaned and sterilized to minimize the risk of infection.
• Step 2: Fluoroscopic Guidance Fluoroscopy is utilized to provide real-time imaging of the lower back and the renal cyst. This imaging technique allows the physician to visualize the needle's trajectory as it is inserted into the cyst.
• Step 3: Needle Insertion A thin needle is carefully inserted through the skin and advanced into the renal cyst under fluoroscopic guidance. The physician ensures that the needle is accurately positioned within the cyst to facilitate the injection of the contrast medium.
• Step 4: Contrast Medium Injection Once the needle is correctly placed, a radiopaque contrast medium is injected into the cyst. This contrast agent enhances the visibility of the cyst on X-ray images, allowing for better assessment of its characteristics.
• Step 5: Image Acquisition After the injection of the contrast medium, a series of X-ray images are obtained. These images capture the details of the cyst and its surrounding structures, providing critical information for evaluation.
• Step 6: Image Interpretation The radiologist reviews the obtained images, analyzing the cyst's characteristics, including its shape, wall margins, enhancement properties, and any internal features such as septa or nodular protuberances.
• Step 7: Reporting Finally, a comprehensive written report is generated, summarizing the findings of the study. This report includes the radiologist's interpretation of the images and any recommendations for further management if necessary.

3. Post-Procedure

After the renal cyst study is completed, the patient may be monitored for a short period to ensure there are no immediate complications from the procedure. It is common for patients to experience mild discomfort at the injection site, which typically resolves quickly. The radiologist will provide the patient and referring physician with the written report detailing the findings of the study. Follow-up care may be recommended based on the results, particularly if any concerning features are identified in the cyst that may require further evaluation or intervention.