Imaging of Small Renal Masses: A Medical Success Story

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Imaging of Small Renal Masses

A Medical Success Story

Ronald J. Zagoria¹

^¹ Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1088.

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David R. Bowen 20th President of ARRS 1919-1920

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James T. Case 21st President of ARRS 1920-1921

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Fig. 1A. —Papillary renal cell carcinoma incidentally detected on sonography in 57-year-old man examined for epigastric pain. Sagittal sonogram shows 2-cm hyperechoic renal mass (arrows). CT or MR imaging is mandatory for further evaluation of this mass.

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Fig. 1B. —Papillary renal cell carcinoma incidentally detected on sonography in 57-year-old man examined for epigastric pain. Contrast-enhanced CT scan shows minimally enhancing solid right renal mass (arrow). It is denser than fluid seen in gallbladder and there is no fat in mass.

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Fig. 2A. —Bilateral cystic renal cell carcinoma in 60-year-old man with hematuria. CT scan shows bilateral predominantly cystic renal masses. Mass in left kidney has enhancing components (arrows) typical of renal cell carcinoma. Mass in right kidney is bilobed and 2.5 cm in diameter but appears to be benign.

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Fig. 2B. —Bilateral cystic renal cell carcinoma in 60-year-old man with hematuria. Sagittal sonogram of right kidney shows solid nodule (arrow) in cyst. Patient underwent left radical nephrectomy and right partial nephrectomy.

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Fig. 3A. —One-centimeter oncocytoma in 64-year-old woman with microscopic hematuria. CT scan of right kidney in corticomedullary phase has normal findings. Small renal mass is undetectable in this phase.

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Fig. 3B. —One-centimeter oncocytoma in 64-year-old woman with microscopic hematuria. CT scan during nephrogram phase shows solid 1-cm right renal mass (arrow).

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Fig. 3C. —One-centimeter oncocytoma in 64-year-old woman with microscopic hematuria. Axial gadolinium-enhanced MR image (fast spoiled gradient echo;TR/TE, 150/4.2) of right kidney shows enhancement in renal mass (arrow).

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Fig. 3D. —One-centimeter oncocytoma in 64-year-old woman with microscopic hematuria. Sagittal gadolinium-enhanced spin-echo MR image (450/9) shows mass (arrow) and its relationship to renal sinus. This mass was resected with partial nephrectomy.

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Fig. 4A. —Bilateral renal cell carcinoma in 45-year-old man with hematuria. Contrast-enhanced CT scan shows 5-cm left renal cell carcinoma mass and 2-cm right renal cell carcinoma mass (arrow).

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Fig. 4B. —Bilateral renal cell carcinoma in 45-year-old man with hematuria. Coronal reconstruction image from CT arteriography phase shows segmental and interlobar arteries (arrows) in area of right kidney harboring mass.

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Fig. 4C. —Bilateral renal cell carcinoma in 45-year-old man with hematuria. Sagittal reconstruction image shows peripheral location of tumor (arrow) that was resected with partial nephrectomy.

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Fig. 5A. —Renal cell carcinoma incidentally discovered in 55-year-old woman involved in motor vehicle collision. Mass (arrow) is barely discernible on this CT scan during corticomedullary phase of contrast enhancement.

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Fig. 5B. —Renal cell carcinoma incidentally discovered in 55-year-old woman involved in motor vehicle collision. Mass measuring 1.5 cm (arrow) is more conspicuous on this CT scan obtained 2 min after A during nephrogram phase.

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Fig. 6A. —Renal cell carcinoma in 68-year-old man with solitary kidney. Arterial-phase CT scan shows enhancing solid mass (arrows) in right kidney. Renal cyst is also present.

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Fig. 6B. —Renal cell carcinoma in 68-year-old man with solitary kidney. Coronal reconstruction of CT scan obtained during excretory phase illustrates how mass (arrows) abuts pelvicaliceal system. Mass was resected by partial nephrectomy.

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Fig. 7A. —Pixel mapping of angiomyolipoma containing fat adjacent to angiomyolipoma without detectable fat in 48-year-old woman with abdominal pain. Two solid masses are visible on this CT scan of left kidney. Five-millimeter mass surrounded by square cursor is fat density. Three-centimeter mass (arrow) is solid without detectable fat.

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Fig. 7B. —Pixel mapping of angiomyolipoma containing fat adjacent to angiomyolipoma without detectable fat in 48-year-old woman with abdominal pain. Portion of pixel map (showing Hounsfield unit values) of smaller mass from A confirms fat in this mass. Both masses were resected and found to be angiomyolipomas.

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Fig. 8. —Transitional cell carcinoma in 68-year-old man with gross hematuria. Contrast-enhanced CT scan shows solid 3-cm-diameter mass (arrow) centered in left renal sinus. Mass has displaced renal sinus fat and has invaded kidney parenchyma.

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Fig. 9. —Bilateral renal lymphoma in 47-year-old man. Contrast-enhanced CT scan shows non-contour-deforming solid renal masses in both kidneys in this patient with non-Hodgkin's lymphoma. Masses are homogeneous, which is typical imaging feature of renal lymphoma.

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Fig. 10A. —CT and sonography of cystic renal cell carcinoma in 45-year-old woman with hematuria. Contrast-enhanced CT scan shows 2.5-cm cystic mass in left kidney. Note subtle enhancement in mass.

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Fig. 10B. —CT and sonography of cystic renal cell carcinoma in 45-year-old woman with hematuria. Sonogram shows multilocular cystic mass that is Bosniak class IV lesion based on enhancement seen on CT.

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Fig. 10C. —CT and sonography of cystic renal cell carcinoma in 45-year-old woman with hematuria. Intraoperative sonogram of same mass as in B better shows multilocular cystic spaces.

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Fig. 11A. —Cystic renal cell carcinoma in 67-year-old woman who was examined for pancreatitis. Axial contrast-enhanced CT scan shows central enhancement in 3-cm right renal mass.

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Fig. 11B. —Cystic renal cell carcinoma in 67-year-old woman who was examined for pancreatitis. Coronal reconstruction shows intraparenchymal extent of this tumor (arrows) better than A. On the basis of these findings, patient was treated with radical nephrectomy.

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Fig. 12. —Eight-millimeter renal cell carcinoma mass incidentally detected in 40-year-old woman with abdominal pain. Contrast-enhanced CT scan in patient with hematuria shows cortical mass (arrowhead) that is solid on this 3-mm collimated scan. Mass was resected by partial nephrectomy.

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Fig. 13A. —One-centimeter renal cell carcinoma detected incidentally in 67-year-old man with prostate cancer. Unenhanced CT scan has normal findings.

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Fig. 13B. —One-centimeter renal cell carcinoma detected incidentally in 67-year-old man with prostate cancer. After contrast enhancement, small cystic mass is visible in right kidney. Note clear enhancement (arrowhead) in mass, which was resected by partial nephrectomy.

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Fig. 14. —Renal and pancreatic masses in 37-year-old man with von Hipple-Lindau disease. Two solid renal cell carcinoma masses (straight arrows) are visible in left kidney along with cysts in both kidneys and pancreas (curved arrow). Cystic masses in patients with von Hippel Lindau sometimes contain malignant cells.

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