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Differential Diagnosis of Perinephric Masses on CT and MRI

¹ All authors: Department of Radiology, University of California–San Francisco, 505 Parnassus Ave., Rm. M-372, Box 0628, San Francisco, CA 94143-0628.

View larger version (137K): [in a new window]   Fig. 1. —58-year-old man presenting with gross hematuria and left flank pain. Contrast-enhanced axial portal phase CT image shows large heterogeneous and necrotic renal cell carcinoma (asterisk) invading perinephric space. Significant thickening of renal fascia also is seen.

View larger version (164K): [in a new window]   Fig. 2. —63-year-old man with non-Hodgkin's lymphoma. Contrast-enhanced axial CT image shows bilateral perinephric (arrows) and right peripelvic (asterisk) masses.

View larger version (93K): [in a new window]   Fig. 3A. —43-year-old male renal transplant recipient with biopsy-confirmed posttransplantation lymphoproliferative disorder in hilum of transplanted kidney. Axial T1-weighted image shows hypointense mass (arrow) in hilum of allograft. Note small nonspecific pocket of fluid (asterisk) adjacent to allograft.

View larger version (120K): [in a new window]   Fig. 3B. —43-year-old male renal transplant recipient with biopsy-confirmed posttransplantation lymphoproliferative disorder in hilum of transplanted kidney. Axial T2-weighted image obtained at same level as A shows same lesion (arrow) as predominantly hypointense. Small nonspecific pocket of fluid (asterisk) adjacent to allograft is also seen on this image.

View larger version (124K): [in a new window]   Fig. 3C. —43-year-old male renal transplant recipient with biopsy-confirmed posttransplantation lymphoproliferative disorder in hilum of transplanted kidney. Gadolinium-enhanced axial gradient-echo T1-weighted image obtained with fat suppression at same level as A and B shows minimal enhancement in lesion (arrow) and fluid pocket (asterisk).

View larger version (162K): [in a new window]   Fig. 4. —76-year-old man with history of malignant melanoma. Contrast-enhanced axial CT image of abdomen shows nodular left perinephric metastasis (arrow). Diagnosis was confirmed by concordant progression of perinephric lesion and widespread metastases elsewhere.

View larger version (142K): [in a new window]   Fig. 5. —77-year-old woman with right upper quadrant pain. Contrast-enhanced axial portal phase CT image shows large heterogeneous mass (arrows), predominantly composed of fat in right upper quadrant, invading perinephric space and renal hilum. Surgical resection established diagnosis of myxoid liposarcoma.

View larger version (143K): [in a new window]   Fig. 6. —67-year-old woman with angiomyolipoma of left kidney presenting as acute left flank pain. Unenhanced axial CT image shows perirenal hematoma (arrow) originating from ruptured angiomyolipoma (asterisk).

View larger version (108K): [in a new window]   Fig. 7A. —67-year-old man with flank pain after aortic aneurysm repair. Contrast-enhanced axial arterial phase CT image shows fluid collection in left perirenal space (arrow) and adjacent to aorta. Appearance of aorta is due to tortuosity and postoperative changes. Perinephric hematoma (asterisk) also is evident.

View larger version (104K): [in a new window]   Fig. 7B. —67-year-old man with flank pain after aortic aneurysm repair. Contrast-enhanced axial delayed CT image obtained at same level as A shows excreted contrast material passing from left renal pelvis (arrow) into perinephric fluid collection (asterisk), confirming diagnosis of urinoma.

View larger version (172K): [in a new window]   Fig. 8A. —Pregnant 31-year-old woman with hereditary lymphangiomatosis. Diagnosis was confirmed by aspiration of chyle from perinephric cystic lesions. Longitudinal sonogram shows cystic structures around right renal pelvis (asterisk) and kidney (arrow).

View larger version (109K): [in a new window]   Fig. 8B. —Pregnant 31-year-old woman with hereditary lymphangiomatosis. Diagnosis was confirmed by aspiration of chyle from perinephric cystic lesions. Axial fast spin-echo T2-weighted image shows multiple bilateral perirenal (arrows) and peripelvic (asterisks) cystic structures.

View larger version (145K): [in a new window]   Fig. 8C. —Pregnant 31-year-old woman with hereditary lymphangiomatosis. Diagnosis was confirmed by aspiration of chyle from perinephric cystic lesions. Coronal single-shot fast spin-echo T2-weighted image shows same perirenal (arrows) and peripelvic (asterisks) cysts seen in B.

View larger version (154K): [in a new window]   Fig. 9. —51-year-old woman with xanthogranulomatous pyelonephritis and history of staghorn calculus and chronic urinary tract infection. Axial late arterial phase contrast-enhanced CT image shows enlarged right kidney with abscesslike low-density cavity (asterisk) in renal hilum. Staghorn calculus is noted (arrowheads) and was also seen on unenhanced images (not shown). Perirenal space extension of inflammatory process (arrow) also is visible.

View larger version (131K): [in a new window]   Fig. 10. —68-year-old man with extramedullary hematopoiesis due to myelofibrosis. Contrast-enhanced axial CT image obtained during portal venous phase shows large hypodense, hypovascular mass encasing right renal hilum, distorting collecting system (asterisk). Lesion (arrows) is also seen in perirenal space bilaterally. Note preservation of renal contours. Appearance is nonspecific. Diagnosis was established by biopsy.

View larger version (181K): [in a new window]   Fig. 11. —51-year-old man with retroperitoneal fibrosis. Contrast-enhanced axial delayed CT image shows hypodense, nonenhancing mass extending into right renal hilum (white arrow) with associated hydronephrosis (asterisk) and renal atrophy. Subtle extension of retroperitoneal process anterior to left kidney (black arrow) also is present. Appearance is nonspecific, and differential includes malignancy such as lymphoma. Diagnosis was confirmed by biopsy.

View larger version (131K): [in a new window]   Fig. 12. —24-year-old woman with 2-year history of Rosai-Dorfman disease. Contrast-enhanced axial delayed CT image shows that left renal hilum is encased by large lobulated hypodense and hypovascular mass and that pelvicaliceal system (asterisk) is compressed. Appearance is nonspecific. Diagnosis was established by biopsy.

View larger version (110K): [in a new window]   Fig. 13A. —48-year-old man with Erdheim-Chester disease presenting with flank and extremity pain. Contrast-enhanced axial CT image shows left perinephric hypovascular mass (arrow) associated with fat stranding. Note moderate hydronephrosis (asterisk). Appearance is nonspecific.

View larger version (85K): [in a new window]   Fig. 13B. —48-year-old man with Erdheim-Chester disease presenting with flank and extremity pain. Conventional radiograph of right and left femurs shows typical cortical and medullary sclerosis. Findings are bilateral and symmetric. Erdheim-Chester disease was raised as possible diagnosis in view of femoral abnormalities and was confirmed by biopsy of perinephric tissue.

View larger version (131K): [in a new window]   Fig. 14. —33-year-old woman with acute renal failure from cortical necrosis after severe antepartum hemorrhage. Contrast-enhanced axial CT image shows lack of enhancement of renal cortex (arrow) with normal renal medulla enhancement. Note slight enhancement of renal capsule (arrowheads).

View larger version (119K): [in a new window]   Fig. 15. —9-month-old boy with nephroblastomatosis. Axial contrast-enhanced CT image shows that kidneys are bilaterally enlarged due to cortical hypodense, non-enhancing, soft-tissue mass (arrows). Note distorted renal parenchyma centrally.

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