Posted in General Ultrasound on May 13, 2014 by m.khodeer
73 year male, weight loss, lower Extremity Swelling. Renal US
Left Kidney
DDx? Comments? Further studies?



Answers
Bilateral Renal Cell CA w/ IVC extension


- RCC = hypernephroma; 80-90% of all adult renal malignancies; 6th-7th decade
- Frequently hyperechoic, especially in tumors <3 cm="" but="" anechoic="" rim="" span="">
- Mets. To lung, nodes, liver, bone, adrenals, contralateral kidney
- IVC involvement = stage IIIA, but contralateral mets. Makes this stage IV
- Associated w/ VHL syndrome, hemodialysis, aquired cystic disease, phenacetin
- All solid renal masses in adults should be assumed RCC until proven otherwise! (e.g., show the presence of fat in the mass = angiomyolipoma)
Robson Staging Criteria for RCC
Stage I – tumor confined within renal capsule (sharply defined convex interface with peripheral fat)
Stage II – extension into perionephric fat but confined to Gerota’s fascia (irregular interface between tumor and fat)
Stage IIIA – extension into renal vein or IVC
Stage IIIB – regional lymph node metastases
Stage IIIC – extension into renal vein and lymph nodes
Stage IVA – extension of adjacent organs (other than ipsilateral adrenal)
Stage IVB – distant metastases
Staging accuracy: 84-91% for CT, 82-96% for MR, poor for US
Tags Bilateral Renal Cell CA, renal ultrasound