Presentation
Right flank pain associated with nausea and haematuria. Known case of non-functioning right kidney.
Patient Data
Two moderately enhancing cortical based mass lesions measuring approximately 5.5 x 5.6 x 6.4 cm and 5.5 x 4.6 x 5.0 cm are seen at the upper and lower pole of the right kidney respectively. A minimally enhancing lesion is seen in the renal pelvis which is extending into the proximal and mid ureter. Some hyperdensities (average density=70 HU), likely blood, are seen in the right renal calyces (history of haematuria). Mild right perinephric fat stranding. A few small serpiginous vessels are seen related to upper and lower pole of the right kidney. Patent right renal artery, right renal vein and IVC. Minimal contrast excretion is seen from the right kidney on the delayed phase. Left kidney and urinary bladder are unremarkable. Multiple small sub centimetre loco-regional, para-aortic and aorto-caval lymph nodes are noted. 12 mm nodule in the left adrenal gland (average density= -3 HU) which is likely an adrenal adenoma. Status post cholecystectomy.
Pharmaceutical and imaging technique: Study was performed after intravenous injection of 155 MBqs of Tc-99m DMSA. Planar images in anterior, posterior, left and right anterior oblique, left and right posterior oblique projections were acquired 3 hours post injection.
Description: Left kidney shows smooth outlines with homogeneous radiotracer distribution. No cortical scar is seen in the left kidney. Right kidney is seen as a rim of significantly reduced radiotracer uptake. Differential renal function: Left kidney=97%, right kidney=3%.
Histopathology and immunohistochemistry report of the right radical nephroureterectomy and regional lymph node dissection specimen.
Case Discussion
Tc-99m DMSA showed poor functioning/non-functioning right kidney and good functioning left kidney with no evidence of cortical scar.
Three right renal masses with one of them involving the renal collecting system and ureter, associated with poor contrast excretion. No invasion of renal vessels or IVC is seen. Possible differentials include transitional cell carcinoma (TCC), renal cell carcinoma (RCC) and renal lymphoma, the latter proven after radical nephroureterectomy.
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