CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 32 Focal Solid Renal Masses
on Computed Tomography

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GU 32-1 Renal cell carcinoma. Large mass
(M) of the left kidney with thickening of
Gerota's fascia (arrows).30

4. • Fig GU 32-2 Angiomyolipoma. Fatty mass (long
arrow) intermixed with (short arrow) and
surrounded by (arrowheads) areas of tissue
density, representing intratumoral and
perinephric hemorrhage, respectively.31

5. • Fig GU 32-3 Multiple renal hamartomas in
tuberous sclerosis. Innumerable low-
attenuation masses in both kidneys.

6. • Fig GU 32-4 Renal oncocytoma. Well-defined,
homogeneous mass in the upper pole of the
right kidney. (Small cysts are present
bilaterally.)28

7. • Fig GU 32-5 Lymphoma. The right kidney is
completely replaced by a lymphomatous mass
(L). Note the extensive nodal involvement (N).

8. • Fig GU 32-6 Lymphoma. (A) Initial unenhanced
scan shows an enlarged kidney with
subcapsular soft-tissue attenuation (arrows)
and an ill-defined lesion posteriorly. (B)
Contrast scan confirms the presence of both
subcapsular and parenchymal masses
(arrows).32

9. • Fig GU 32-7 Transitional cell carcinoma. Filling
defect (arrow) in the opacified renal pelvis.

10. • Fig GU 32-8 Transitional cell carcinoma.
Diffuse tumor infiltration of the left kidney
with preservation of its reniform contour.33

11. • Fig GU 32-9 Wilms' tumor. Large low-density
mass pushing the functioning portion of the
left kidney (arrow) across the midline.

12. • Fig GU 32-10 Bilateral Wilms' tumor. Huge left
renal mass (W) that crosses the midline. There
is also a small separate mass (w) in the right
kidney.33

13. • Fig GU 32-11 Acute pyelonephritis.
Postcontrast scan shows characteristic low-
density striations (arrows) in the left kidney.

14. • Fig GU 32-12 Renal abscess. Contrast-
enhanced CT scan through both kidneys
demonstrates a discrete low-density area
(arrows), which proved to be an abscess on
diagnostic needle aspiration.

15. • Fig GU 32-13 Renal abscess. Cystic lesion with
adjacent renal parenchymal edema (arrows),
representing a Staphylococcus aureus abscess in
a patient with acquired immunodeficiency
syndrome.32

16. • Fig GU 32-14 Xanthogranulomatous
pyelonephritis. The renal pelvis (p) and intrarenal
collecting structures are filled with low-density
pus. Note the prolonged opacification of the left
renal cortex and the high-density focus (arrow)
representing a renal calculus.34

17. • Fig GU 32-15 Infarction. Two wedge-shaped
areas of decreased attenuation (arrows) in the
right kidney.

18. • Fig GU 32-16 Renal contusion. Contrast scan
demonstrates a focal area of decreased
enhancement in the interpolar region of the
left kidney (arrowhead).35

19. • Fig GU 32-17 Subcapsular hematoma. Contrast scan demonstrates a
subcapsular fluid collection (straight white arrows) flattening the
posterolateral contour of the left kidney. There is minimal cortical
laceration (black arrow). Note also the subcutaneous emphysema in
the left side of the back (curved arrow). A chest tube had been
inserted for a left pneumothorax (not shown).35

20. • Fig GU 32-18 Multiple renal lacerations. Contrast scan shows
several deep lacerations of the interpolar region of the right kidney
(straight arrows) associated with areas of active arterial
extravasation (curved arrows) Note the anterior displacement of
the duodenum (D), pancreas (P), and inferior vena cava (V). A
hemoperitoneum (H) is seen in Morrison's pouch.35

21. • Fig GU 32-19 Shattered kidney. Contrast scan
demonstrates a devitalized upper pole of the
right kidney due to segmental infarction (RP).
Note the perinephric hyperattenuating blood clot
(arrow). Flattening of the inferior vena cava (V)
indicates hypovolemic shock.35