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Renal cysts Large simple renal cysts on ultrasound appear as black, fluid-filled spaces with smooth, thin walls and posterior acoustic enhancement. They are typically round or oval and show no internal blood flow on color Doppler, indicating their benign nature. Management usually involves periodic monitoring, with intervention only if symptomatic. Renal cysts with thick septations appear more complex, featuring irregular, thick septations and possible internal echoes. Color Doppler may show vascularity within the septations, raising concerns about potential malignancy. These cysts require further evaluation with contrast-enhanced imaging, regular monitoring, and possibly surgical intervention if malignancy is suspected or if significant symptoms occur. Simple cysts generally have an excellent prognosis, while complex cysts need careful assessment to rule out malignancy. Regular follow-up and monitoring are crucial to detect any changes that might indicate progression towards a more suspicious nature.