Presentation
Left flank pain with hematuria on lab data. Referred to CT scan for rule out of probable left ureteral stone.
Patient Data
Multiple small diverticula are seen at the left hemicolon. Focal wall thickening with mild surrounding fat stranding is also observed at the proximal of descending colon, suggesting colonic diverticulitis.
In addition, a 62 x 75 mm mass is seen in the lower pole of the left kidney that bulges into the renal collecting system. The neoplasm has a similar density to normal renal parenchyma on non-enhanced CT scan. After IV contrast media injection, the attenuation value increased from 36 HU to 98 HU. A nephrographic phase CT scan shows that the mass enhances less than normal renal parenchyma.
The gallbladder is not seen at the anatomical location due to prior resection.
Case Discussion
This 65-year-old patient with acute left flank pain and hematuria on lab data referred to the CT scan to rule out probable left ureteral stone. Still, on CT images, segmental descending colon wall thickening and adjacent diverticula suggest diverticulitis which explains the patient's left flank pain.
On the other hand, a large left renal mass that bulges into the renal collecting system causes hematuria. The patient underwent a left nephrectomy, and histopathology evaluation confirmed clear cell renal cell carcinoma, the most common type of renal cell carcinoma.