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CT Findings After Nephron-Sparing Surgery of Renal Tumors

Mu Sook Lee1, Young Taik Oh1, Woong Kyu Han2, Koon Ho Rha2, Young Deuk Choi2, Sung Joon Hong2, Seung Choul Yang2 and Ki Whang Kim1

1 Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seodaemun-ku Shinchon-dong 134, Seoul 120-752, Republic of Korea.
2 Department of Urology, Yonsei University College of Medicine, Seoul, Republic of Korea.


Figure 1
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  		Fig. 1A —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 2
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  		Fig. 1B —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 3
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  		Fig. 1C —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 4
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  		Fig. 1D —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 5
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  		Fig. 1E —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 6
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  		Fig. 1F —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 7
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  		Fig. 1G —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 8
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  		Fig. 1H —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 9
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  		Fig. 1I —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 10
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  		Fig. 1J —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 11
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  		Fig. 1K —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 12
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  		Fig. 1L —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 13
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  		Fig. 1M —Techniques for nephron-sparing surgery for kidney tumors. Drawings illustrate segmental resection (A–D), wedge resection (E–G), transverse resection (H–J), and enucleation (K–M).

 

Figure 14
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  		Fig. 2A —Round postoperative granuloma in 47-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On preoperative axial corticomedullary phase CT, 3-cm-diameter solid mass (arrow) is seen in left kidney.

 

Figure 15
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  		Fig. 2B —Round postoperative granuloma in 47-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase (B) and axial parenchymal phase (C) CT performed 3 months after nephron-sparing surgery, delayed, minimally enhancing, and round postoperative granuloma is seen at excision site (arrow) in left kidney.

 

Figure 16
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  		Fig. 2C —Round postoperative granuloma in 47-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase (B) and axial parenchymal phase (C) CT performed 3 months after nephron-sparing surgery, delayed, minimally enhancing, and round postoperative granuloma is seen at excision site (arrow) in left kidney.

 

Figure 17
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  		Fig. 2D —Round postoperative granuloma in 47-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On axial parenchymal phase CT performed 6 months after nephron-sparing surgery, size of round postoperative granuloma has decreased (arrow).

 

Figure 18
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  		Fig. 3A —Fat at excision site in 53-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On preoperative axial parenchymal phase CT, 4-cm-diameter solid mass (arrow) is seen in left kidney.

 

Figure 19
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  		Fig. 3B —Fat at excision site in 53-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase CT performed 3 months after nephron-sparing surgery, low-density lesion with negative CT attenuation (–45 H) is seen at excision site (arrow), suggesting fat at excision site.

 

Figure 20
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  		Fig. 4A —Linear or stellate parenchymal scar in 33-year-old man after right nephron-sparing surgery for angiomyolipoma. On preoperative axial parenchymal phase CT, large fat-containing mass (arrow) is seen in right kidney.

 

Figure 21
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  		Fig. 4B —Linear or stellate parenchymal scar in 33-year-old man after right nephron-sparing surgery for angiomyolipoma. On axial parenchymal phase CT performed 3 months after nephron-sparing surgery, 2-mm-diameter, narrow elongated linear line (arrow) that runs through renal parenchyma is seen at surgical site in right kidney. Line shows no enhancement.

 

Figure 22
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  		Fig. 5A —Parenchymal defect in 44-year-old woman after right nephron-sparing surgery. On axial corticomedullary phase CT performed 4 months after nephron-sparing surgery, sharply demarcated renal parenchyma defect involving mainly cortex (arrow) is seen in right kidney.

 

Figure 23
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  		Fig. 5B —Parenchymal defect in 44-year-old woman after right nephron-sparing surgery. On axial parenchymal phase CT performed 14 months after nephron-sparing surgery, parenchymal defect with no significant change (arrow) is seen in surgical site.

 

Figure 24
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  		Fig. 6A —Perinephric strands in retroperitoneal space in 53-year-old man after nephron-sparing surgery for renal cell carcinoma. On preoperative axial parenchymal phase CT, 2-cm-diameter solid mass is seen in right kidney (arrow).

 

Figure 25
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  		Fig. 6B —Perinephric strands in retroperitoneal space in 53-year-old man after nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase CT performed 3 months after nephron-sparing surgery, linear strands are seen in retroperitoneal space (arrows).

 

Figure 26
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  		Fig. 7A —Mass-like lesion in retroperitoneal space in 65-year-old man after right nephron-sparing surgery for papillary neoplasia. On preoperative axial unenhanced CT, 1.5-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 27
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  		Fig. 7B —Mass-like lesion in retroperitoneal space in 65-year-old man after right nephron-sparing surgery for papillary neoplasia. On axial corticomedullary phase CT performed 6 months after nephron-sparing surgery, mass-mimicking lesion with soft-tissue density is seen in retroperitoneal space (arrow) with no enhancement or mass effect.

 

Figure 28
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  		Fig. 7C —Mass-like lesion in retroperitoneal space in 65-year-old man after right nephron-sparing surgery for papillary neoplasia. On axial parenchymal phase CT performed 1 year after nephron-sparing surgery, extent of mass-like lesion has decreased (arrow).

 

Figure 29
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  		Fig. 8A —Mixture of perinephric strands and mass-like lesion in retroperitoneal space in 47-year-old man after right nephron-sparing surgery for renal cell carcinoma. On preoperative axial parenchymal phase CT, 1-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 30
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  		Fig. 8B —Mixture of perinephric strands and mass-like lesion in retroperitoneal space in 47-year-old man after right nephron-sparing surgery for renal cell carcinoma. On axial parenchymal phase CT performed 6 months after nephron-sparing surgery, soft-tissue-density lesion (solid arrow) with perinephric strands (dashed arrow) is seen in retroperitoneal space with no enhancement.

 

Figure 31
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  		Fig. 8C —Mixture of perinephric strands and mass-like lesion in retroperitoneal space in 47-year-old man after right nephron-sparing surgery for renal cell carcinoma. On axial parenchymal phase CT performed 2 years after nephron-sparing surgery, extent of mixture of perinephric strands and mass-like lesion in retroperitoneal space has decreased.

 

Figure 32
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  		Fig. 9A —Local recurrence at surgical site in 41-year-old man after right nephron-sparing surgery for renal cell carcinoma. On preoperative axial corticomedullary phase CT, 1-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 33
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  		Fig. 9B —Local recurrence at surgical site in 41-year-old man after right nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase CT performed 3 months after nephron-sparing surgery, marked enhancing recurring nodule (arrow) is seen at excision site.

 

Figure 34
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  		Fig. 10A —Local recurrence at surgical site in 56-year-old woman after right nephron-sparing surgery for renal cell carcinoma. On preoperative axial parenchymal phase CT, 1-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 35
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  		Fig. 10B —Local recurrence at surgical site in 56-year-old woman after right nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase CT performed 3 months after nephron-sparing surgery, small, strongly enhancing nodule (arrow) is seen at surgical site.

 

Figure 36
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  		Fig. 10C —Local recurrence at surgical site in 56-year-old woman after right nephron-sparing surgery for renal cell carcinoma. On sequential axial corticomedullary phase CT, size of enhancing nodule (arrow) has increased. Nodule was found to be local recurrence.

 

Figure 37
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  		Fig. 11A —Recurrence at perinephric space in 41-year-old man after right nephron-sparing surgery for renal cell carcinoma. On preoperative axial corticomedullary phase CT, 1-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 38
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  		Fig. 11B —Recurrence at perinephric space in 41-year-old man after right nephron-sparing surgery for renal cell carcinoma. On axial corticomedullary phase CT performed 3 months after nephron-sparing surgery, multiple enhancing recurrent nodules (arrows) are seen at perinephric site.

 

Figure 39
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  		Fig. 12A —In 74-year-old man, hematoma as complication after right nephron-sparing surgery for renal cell carcinoma. Gross hematuria and anemia developed 2 weeks after surgery. On preoperative axial corticomedullary phase CT, large heterogeneously enhancing solid mass (arrow) is seen in right kidney.

 

Figure 40
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  		Fig. 12B —In 74-year-old man, hematoma as complication after right nephron-sparing surgery for renal cell carcinoma. Gross hematuria and anemia developed 2 weeks after surgery. On axial unenhanced CT performed 2 weeks after nephron-sparing surgery, homogeneous mass (arrows) with attenuation of 70 H is seen around surgical clips.

 

Figure 41
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  		Fig. 12C —In 74-year-old man, hematoma as complication after right nephron-sparing surgery for renal cell carcinoma. Gross hematuria and anemia developed 2 weeks after surgery. Coronal reformatted unenhanced CT also shows hyperattenuated mass, which is consistent with hematoma at surgical site (arrows).

 

Figure 42
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  		Fig. 13A —Abscess as complication of nephron-sparing surgery in 66-year-old man after right nephron-sparing surgery. On preoperative axial parenchymal phase CT, 1.5-cm-diameter solid mass (arrow) is seen in right kidney.

 

Figure 43
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  		Fig. 13B —Abscess as complication of nephron-sparing surgery in 66-year-old man after right nephron-sparing surgery. On axial parenchymal phase CT performed 2 weeks after nephron-sparing surgery, loculated fluid collection with thick enhancing wall (arrows) is seen at anterior pararenal space. This was found to be abscess.

 

Figure 44
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  		Fig. 13C —Abscess as complication of nephron-sparing surgery in 66-year-old man after right nephron-sparing surgery. On axial parenchymal phase CT performed 3 months after nephron-sparing surgery, postoperative abscess has disappeared.

 

Figure 45
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  		Fig. 14A —Ischemia as complication of nephron-sparing surgery in 39-year-old woman after left nephron-sparing surgery for cystic renal cell carcinoma. On preoperative axial corticomedullary phase CT, cystic mass with enhancing thick septa (arrow) is seen in left kidney.

 

Figure 46
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  		Fig. 14B —Ischemia as complication of nephron-sparing surgery in 39-year-old woman after left nephron-sparing surgery for cystic renal cell carcinoma. On axial parenchymal phase CT performed 1 year after nephron-sparing surgery, parenchyma at surgical site shows decreased enhancement and mild atrophied change (arrow) in comparison with remnant renal parenchyma.

 

Figure 47
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  		Fig. 14C —Ischemia as complication of nephron-sparing surgery in 39-year-old woman after left nephron-sparing surgery for cystic renal cell carcinoma. On coronal reformatted parenchymal phase CT, ischemic change is also seen at surgical site (arrow). Change was regarded as postoperative ischemia.

 

Figure 48
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  		Fig. 15 —Another case of ischemia in 45-year-old man after right nephron-sparing surgery for renal cell carcinoma. On coronal reformatted parenchymal phase CT, right kidney shows atrophied change and lack of parenchymal enhancement.

 

Figure 49
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  		Fig. 16A —Ureteral or renal pedicle stricture as complication of nephron-sparing surgery in 55-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On preoperative coronal reformatted parenchymal phase CT, 3-cm-diameter solid mass (arrow) is seen in left kidney.

 

Figure 50
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  		Fig. 16B —Ureteral or renal pedicle stricture as complication of nephron-sparing surgery in 55-year-old woman after left nephron-sparing surgery for renal cell carcinoma. On axial parenchymal phase CT performed 1 year after nephron-sparing surgery, renal vascular luminal narrowing (arrow) and hydronephrosis with parenchymal atrophy are seen, suggesting ureteral or renal pedicle stricture.

 

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