Presentation
Acute frank hematuria with a large mass palpable in the lower right quadrant of the abdomen.
Patient Data
Ultrasound shows a large heterogenous lower pole right renal tumor, with no adjacent hepatic, nodal or vascular invasion seen. The lesion shows cystic degeneration with mildly increased vascularity on color Doppler.
A heterogeneous mass arises from the right kidney measuring approximately 7.6 x 8.6 x 8.3 cm. The lesion is complex with some internal areas of cystic necrosis, and areas of restricted diffusion. It abuts the inferior border of the liver but does not show invasion. The mass also mildly effaces the IVC, with no evidence of tumor invasion. The right renal vein is effaced by the mass, thus any tumor invasion at this vascular level cannot be excluded.
No focal lesion in the liver or intra-abdominal lymphadenopathy.
Case Discussion
Wilms tumor is the most common solid malignant tumor of the kidney in children.
It may present by abdominal mass, frank hematuria, fever, hypertension or fatigue.
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