Renal cell carcinoma vs renal pelvic transitional cell carcinoma
Incidental right renal mass observed on CT performed for an alternative indication. Patient asymptomatic.
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Heterogenous mass in the central right kidney - either derived from central renal parenchyma tissue or the renal pelvis.
Incidental heterogenous mass centred on the central right kidney. The differential is between a centrally placed renal cell carcinoma or a renal pelvis transitional cell carcinoma.
This study was performed for an alternative indication and hence only a single portal venous phase. If the clinical indication pertained to the renal tract a multiphase study would have been performed making the diagnosis more straightforward.
Discussed at a clinico-radiological meeting as to whether it was a renal cell carcinoma or a pelvic transitional cell carcinoma.
Multi-phase imaging offered, in particular a excretory phase study to delineate of this mass is renal parenchymal derived or within the pelvis - in which case it would be clearly elucidated as a filling defect in the renal pelvis. Urologists decided to perform a retrograde study in theatre - no collecting system abnormality (images not available).
Final diagnosis was of a renal cell carcinoma.
The case highlights the value of:
- good referral practices
- importance of robust vetting and protocol selection
- value of clinico-radiological discussion
- holistic approach to imaging with multi-modality studies