History of excision of a left renal tumor with renal conserving surgery 8 years ago. Lost to follow for 5 years.
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The left suprarenal gland shows four lesions, the largest lesion measuring 6.3 x 7.8 x 7.4 cm in AP, SS and CC dimensions. They show heterogeneous post-contrast enhancement, mainly peripheral with gradual filing in along the multiphasic study.
The largest one shows local mass effect, indenting the anterior border of the left kidney, contacting the left crus of diaphragm with downward displacing the left renal hilar vessels.
Left renal hilar enhancing lymph node is noted.
Left posterior pararenal rounded enhancing lesion is noted.
Left renal lower pole subcapsular lesion measuring 2.2 x 2.5 cm with arterial enhancement and washout in venous and delayed phases, suspicious for a recurrent left renal malignant lesion.
This case represents multiple left adrenal lesions, small left renal hilar lymph node and posterior pararenal lesion, the possibility of metastatic deposits are of prime consideration considering history of ipsilateral renal conserving surgery for a renal tumor. A lower pole recurrent renal suspicious lesion is also noted.