Wilms tumor

Case contributed by Hani Makky Al Salam

Presentation

Non-tender abdominal lump.

Patient Data

Age: 4 years
Gender: Female

Abdomen and pelvis

ct

A very large heterogeneously enhancing soft-tissue density mass appears to arise from the left kidney and results in hydronephrosis of the collecting system which is located posterior to the mass. The mass is well circumscribed without evidence of direct extension in adjacent organs/structures. No convincing nodal enlargement. 

Annotated images

Annotated image

Low-density filling defect (red arrow) in the left renal vein suggesting extension of the tumor. 

Claw sign is strong evidence that the mass arises from the kidney. Note how the renal parenchyma is stretched around the mass at the margins (yellow arrows). 

Bone scan

Nuclear medicine

Bone scan (bone phase) using 99mTc-methylene diphosphonate (MDP) demonstrates no abnormal uptake in the skeleton. 

Case Discussion

This patient went on to have a biopsy which confirmed the diagnosis of Wilms tumor

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