Presentation
Flank pain, hematuria.
Patient Data
Masslike enlargement of the left mid through upper kidney with involvement of the adrenal gland. Dense material in the renal pelvis and proximal ureter. Adenopathy along the medial aspect.
Infiltrative mass replacing and expanding the left upper half of the kidney. Extends into left adrenal gland. Small surrounding lymph nodes. Left ureteral thickening and enhancement.
Case Discussion
Notice how easy it would be to misinterpret the flank pain study as pyelonephritis, particularly on the axial images. The masslike involvement becomes much more apparent on the coronal reformats, and the extent of disease is better characterized on the follow-up contrast enhanced exam. This diagnosis of urothelial carcinoma was confirmed by ultrasound-guided biopsy of the kidney.
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