Figure 1 A 45-year-old man with autosomal dominant polycystic kidney disease presented to the urology clinic for consideration of bilateral nephrectomy as treatment for severe abdominal pain and distention. Magnetic resonance imaging of the abdomen (Panel A) demonstrated profound enlargement and complete replacement of the liver (top arrow) and kidneys (lower arrows) by cysts. A bilateral nephrectomy was performed (Panel B), with removal of a left kidney measuring 29 cm by 20 cm by 14 cm (weight, 3100 g) and a right kidney measuring 28 cm by 14 cm by 11 cm (weight, 1600 g). The kidneys contained cysts as large as 5 cm in diameter. The patient noted an immediate improvement in abdominal pain and a marked decrease in abdominal distention.