What is the recommended treatment plan for a patient with multiple bilateral renal cortical cysts, colonic diverticulosis, mild prostate enlargement, fatty liver infiltration, and atherosclerotic calcifications, who had a recent computed tomography (CT) scan of the abdomen and pelvis?

Management of Incidental CT Findings in Asymptomatic Patient

For this patient with multiple bilateral renal cortical cysts, colonic diverticulosis, and other incidental findings on CT, the primary management is routine yearly imaging surveillance of the renal cysts, lifestyle modifications for cardiovascular risk factors, and watchful waiting for the other findings—no immediate intervention is required for any of these incidental findings.

Renal Cysts Management

The bilateral renal cortical cysts (largest 4.5 cm) with tiny concretions require annual follow-up imaging but no active treatment. 1

• These simple cortical cysts are benign findings that do not require intervention unless they become symptomatic (pain, infection, bleeding) or show concerning features 1, 2
• The CT report indicates these are simple cysts without complex features (no septations, wall thickening, enhancement, or solid components) 3
• The tiny 2-3 mm concretions noted are likely small calcifications or stones that are clinically insignificant at this size 1
• Annual imaging surveillance is appropriate to monitor for any changes in cyst size, number, or characteristics 1
• Ultrasound is acceptable for follow-up monitoring in adults, though CT provides more detailed assessment 1

Critical Pitfall to Avoid

Do not pursue surgical intervention for simple renal cysts unless they cause symptoms (obstruction, infection, pain) or develop complex features suggesting malignancy 1, 3

Colonic Diverticulosis Management

The multiple colonic diverticula are asymptomatic and require only dietary modifications—no medical or surgical treatment is indicated. 1

• Diverticulosis (presence of diverticula) is distinct from diverticulitis (inflammation/infection) 1
• The CT shows diverticulosis with fecal loading but no evidence of acute diverticulitis (no pericolonic fat stranding, abscess, or perforation) 1
• Recommend high-fiber diet and adequate hydration to prevent constipation and reduce risk of future diverticulitis 1
• No antibiotics, colonoscopy, or surgical consultation needed for uncomplicated diverticulosis 1
• Advise patient to seek care if develops left lower quadrant pain, fever, or change in bowel habits (signs of acute diverticulitis) 1

Fatty Liver Management

The mild hepatic steatosis requires cardiovascular risk factor modification but no specific liver-directed therapy.

• Mild fatty infiltration is common and typically related to metabolic syndrome, obesity, diabetes, or dyslipidemia 1
• Screen for and manage cardiovascular risk factors: check fasting glucose, HbA1c, lipid panel 4
• Recommend weight loss if overweight, exercise, and dietary modifications (reduce saturated fats, simple carbohydrates, alcohol) 4
• Consider statin therapy if dyslipidemia is present, as statins are safe in mild fatty liver disease 4
• No need for liver biopsy or hepatology referral for mild, asymptomatic fatty infiltration 1

Prostate and Bladder Findings

The mild prostatic enlargement and bladder wall thickening are age-related changes requiring only symptom assessment.

• Mild benign prostatic hyperplasia (BPH) with calcification is common in aging men and does not require treatment if asymptomatic
• Assess for lower urinary tract symptoms (frequency, urgency, nocturia, weak stream, incomplete emptying)
• If symptomatic, consider alpha-blocker therapy or urology referral
• Mild bladder wall thickening may be related to BPH-induced outlet obstruction or chronic overdistension from incomplete emptying
• No imaging follow-up needed unless symptoms develop

Atherosclerotic Disease Management

The coronary and aortic calcifications indicate established atherosclerotic disease requiring aggressive cardiovascular risk reduction. 4

• Initiate or optimize statin therapy for secondary prevention (target LDL <70 mg/dL) 4
• Recommend aspirin 81 mg daily unless contraindicated (bleeding risk)
• Aggressive management of hypertension (target <130/80 mmHg), diabetes if present (HbA1c <7%), and smoking cessation 4
• Consider cardiology referral if patient has symptoms of coronary disease (chest pain, dyspnea) or for risk stratification

Inguinal Hernias

The bilateral fat-containing inguinal hernias require surgical evaluation only if symptomatic.

• Asymptomatic, reducible inguinal hernias can be observed with watchful waiting
• Refer to general surgery if: pain, inability to reduce, signs of incarceration/strangulation, or patient preference for repair
• Advise patient to avoid heavy lifting and straining

Spinal Degenerative Changes

The lumbar spine degenerative changes are age-appropriate and require only symptomatic management.

• Osteophytic lipping is a normal aging process
• Manage with physical therapy, NSAIDs, and activity modification if patient has back pain
• No imaging follow-up needed unless new neurologic symptoms develop (radiculopathy, weakness, bowel/bladder dysfunction)

Summary of Follow-Up Plan

• Renal cysts: Annual imaging (ultrasound or CT) 1
• Cardiovascular risk: Lipid panel, glucose/HbA1c, initiate statin if indicated 4
• Lifestyle modifications: High-fiber diet, weight loss if overweight, exercise, smoking cessation 1, 4
• Symptom monitoring: Assess for urinary symptoms (BPH), abdominal pain (diverticulitis), hernia symptoms 1
• No immediate intervention required for any of the CT findings unless symptoms develop