9 Focal Renal Mass

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GU 9-1 Column of Bertin. (A) Excretory urogram shows displacement of the upper calyceal system of the right kidney. (B) Film from the nephrotomogram phase of a selective right renal arteriogram shows the large column (arrows), which appears denser than the medullary substance. Renal scans (C, D) show normal-functioning parenchyma.7

• Fig GU 9-2 Renal cysts. Nephrotomogram demonstrates bilateral renal cysts (arrows).

• Fig GU 9-3 Renal cyst puncture. (A) The instillation of contrast material shows the smooth inner wall characteristic of a benign cyst. (B) In another patient, the introduction of contrast material reveals the markedly irregular inner border of a necrotic renal cell carcinoma.

Fig GU 9-4 Renal cell carcinoma. Nephrotomogram demonstrates a lucent, welldemarcated renal mass with a thick wall (arrows).8

Fig GU 9-6 Wilms' tumor. Huge mass in the right kidney distorts and displaces the pelvocalyceal system.2

• Fig GU 9-7 Renal hamartoma. (A) A combined excretory urogram and inferior vena cavagram shows a large mass in the lower pole of the right kidney with displacement but no invasion of the pelvocalyceal system and inferior vena cava. (B) Arteriography shows the mass to be hypervascular. The overall radiographic appearance is indistinguishable from that of renal cell carcinoma.