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5.2 Renal Masses and Congenital Anomalies
5.2 Renal Masses and Congenital Anomalies
LEGEND
Lecture Powerpoint, Audio, Textbook, 2018 Trans - Nephrogenic phase
- 80 – 180 sec
I. SOLID RENAL NEOPLASM - Most sensitive phase
Hematuria
Flank pain
Palpable Mass
Only 10-15% of the patients presents with these.
IMAGING FINDINGS
NON-CONTRAST PHASE
The thin septations were lined by clear cells, which is typical STELLATE PATTERN
of renal cell carcinoma.
ANGIOMYOLIPOMA
LYMPHOMA
Rare
Commonly involved by metastatic lymphoma or by direct
invasion.
MOC: Multidetector CT scan o Hodgkin lymphoma
Involves the cortex CT
Macroscopic fat o homogenous, round, poorly enhancing
HU of fat (-20) Extensive retroperitoneal adenopathy favors the diagnosis.
METASTASIS
Simple cyst
Complicated cyst
Hyperechoic Renal abscess
Located in the cortex Cystic renal diseases
May exhibit acoustic shadowing o Autosomal dominant polycystic disease
o Autosomal recessive polycystic disease
ONCOCYTOMA o Tubular sclerosis
o Von Hippel-Lindau
o Medullary sponge kidney
Rare renal lesion
Composed of eosinophilic cells (oncocytes)
Difficult to distinguish from RCC SIMPLE RENAL CYST
Average size: 5 – 8 cm
Large tumors Most common type of renal mass.
o stellate central scar Older than age 55.
Angiography: Large cysts (>4 cm)
o Spoke wheel configuration of radiating vessels. o Obstruction, pain, hematuria, or hypertension.
US, CT, and MRI.
Multiple and bilateral
CRITERIA: CT SCAN
- No perceptible wall.
- Homogeneous attenuation
near water density (-10 to
+10 H) AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DISEASE
(ADPKD)
Hereditary
CRITERIA: MRI Renal parenchyma is progressively replaced by multiple
non-communicating cysts of varying size.
Commonly complicated by internal hemorrhage.
30 and 50 years old
Associated findings:
o Increased incidence of aneurysm
o Cysts elsewhere: liver, pancreas and spleen.
Large kidneys with multiple cysts
May have calcifications
SUPERNUMERARY KIDNEYS
Rare anomaly.
Anomalous kidney is small and rudimentary.
Demonstration of separate pelvis, ureter and blood
supply is essential for diagnosis.
Intravenous pyelogram demonstrates pelvis and ureter.
Aortography demonstrates separate blood supply and is
confirmatory.
CT scan, MRI and ultrasound.
Less or non-invasive methods.
HORSESHOE KIDNEY: CT
HORSESHOE KIDNEY
Complications
o UPJ obstruction
o Renal stones
o Wilm’s tumor in children
o Susceptibility to trauma
CROSS-FUSED ECTOPIA
May present as an abdominal mass.
Aberrant renal arteries
Ureters insert in their normal location in the bladder
trigone
Mass – because kidneys are on both sides
Plain x-ray
o Pelvic mass
Its ureter is only long enough to connect renal pelvis to
bladder
Nephroptosis
o Downward displacement and more mobility of
kidney than usual
Intrathoracic kidney
o Projecting into the posterior thorax from below the
diaphragm In complete ureteral duplication, the ureter draining the
Usually unilateral upper pole passes through the bladder wall to insert
inferior and medial to the normally placed ureter that
drains the lower pole.
Upper pole ureter – obstructed because of ectopic
insertion
Lower - inserts in or near the normal location in the
bladder trigone and is subject to reflux because of
distortion in its passage through the bladder wall by
ectopic ureteroceole
URETERAL DUPLICATION
6x more common than bilateral duplication
EXSTROPHY
Absence of lower anterior abdominal wall
Diagnosis is based on observation
Radiography used to study kidneys and ureters
o Dilatation of distal ureter
Wide separation of pubic bones anteriorly at the
symphysis
o Wide diastasis
Bladder is open, its mucosa is continuous with the skin
Epispadia
“Square shaped pelvis”
PATENT URACHUS
Persistent communication between the bladder and
the umbilicus
Urine leak
Discovered in neonatal period
Most common (50%)
URACHAL CYST
Urachus closed at both ends but remains patent in the
middle
VESICOURACHAL DIVERTICULUM
Outpouching of the bladder in the anterior midline
location of the urachus.
5%