Presentation
Right flank pain with palpable mass.
Patient Data
Large well defined heterogeneously enhancing exophytic right renal mass of upper pole location with large central necrosis. No apparent extension beyond the renal capsule. Prominent vascular collaterals around the mass are seen mainly in the portal phase with mild perinephric fat stranding. Renal veins and IVC are patent. Normal appearance of the renal arteries. A mass effect is noted on the calyceal system with no endoluminal extension seen in the excretory phase. A mass effect with upwards displacement of the adrenal gland and liver.
No significant abdominal lymphadenopathy. No focal lesion is seen in the left kidney.
Case Discussion
CT features are of a large heterogeneously enhancing exophytic right renal mass with central necrosis.
The patient went on to have a radical right nephrectomy with a histopathological examination that confirmed the diagnosis of clear cell renal carcinoma.
Clear cell renal cell carcinoma is the most common type of renal cell carcinoma. Over 95% of cases are sporadic and around 5% are familial cases most are seen in Von Hippel-Lindau disease (usually in young patients, the average age of onset is 37 years).