Presentation
Hematuria.
Patient Data
Infiltrative mass involving the majority of the left upper renal pole, which has heterogeneous enhancement and extends and invades into the renal pelvis, filling the central renal pelvis and also extending into lower/interpolar calyces. There is associated urothelial thickening. There is subtle striated enhancement of the left lower renal pole. No surrounding adenopathy. No suspicious liver lesions. Right kidney is normal. No disease elsewhere in the abdomen or pelvis.
Case Discussion
This case illustrates the appearance of a urothelial carcinoma that involves both the renal pelvis and renal parenchyma. At first glance this may be mistaken for either infection or renal cell carcinoma, however major involvement of the renal pelvis is more typical of urothelial carcinoma.
Note the technique using this examination called "split bolus", which involves administering 2 separate doses of contrast medium in order to have both enhancing and excretory phase activity at the same time.
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