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Abdomen » Kidneys/Ureters
Renal Cell Carcinoma CEUS 1
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Presentation A 69 year old female presented with a history of chronic kidney disease stage IV. Ultrasound examination demonstrated a 2.7 cm left renal complicated cyst vs solid mass. 
 
 
 
Caption: Transverse B-mode ultrasound image of the left kidney.
Description: A hypoechoic mass is seen in the upper mid region of the kidney
 
 
 
Caption: Left Kidney
Description: A slightly more medial plane better demonstrates the mass. The lesion exhibits a somewhat irregular outline and hypoechoic internal content. Through transmission appears slightly increased compared with adjacent normal-appearing kidney parenchyma.
 
 
 
Caption: Left Kidney
Description: The mass measures 2.43 cm.
 
 
 
Caption: A dual contrast enhanced ultrasound (CEUS) image with 2D imaging on left and contrast imaging on right.
Description: This image was captured 14 seconds post contrast injection and demonstrated enhancement within the lesion.
 
 
 
Caption: CEUS: 52 seconds post injection
Description: At 52 seconds there is complete enhancement within the lesion.
 
 
 
Caption: CEUS: 1 minute, 45 seconds post injection
Description: Ultrasound image captured 1:45 minutes post contrast injection demonstrates washout within the lesion.
 
 
 
Caption: CEUS: 2 minutes 6 seconds post injection
Description: At 2:06 minutes post contrast injection the lesion continues to demonstrate washout within the lesion.
 
 
Caption: CEUS: Video clip
Description: This CEUS video clip shows initial enhancement followed by washout within the left kidney hyperechoic lesion.
 
Differential Diagnosis Complicated Cyst
Renal Cell Carcinoma
Angiomyolipoma
Oncocytoma
Metastasis
Lymphoma
Renal adenoma
 
Final Diagnosis Renal Cell Carcinoma
 
Discussion

The contrast enhanced ultrasound (CEUS) demonstrated a solid enhancing renal mass, consistent with renal cell carcinoma.

 
Case References
  1. Quantification of Enhancement of Renal Parenchymal Masses with Contrast-Enhanced Ultrasound.   Yingyu Cai, Lianfang Du, Fan Li, Jiying Gu, Min Bai.  Department of Ultrasound, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China    Ultrasound Med Biol. 2014 Jul;40(7):1387-93. doi: 10.1016/j.ultrasmedbio.2014.02.003.   DOI: 10.1016/j.ultrasmedbio.2014.02.003
  2. Renal cell carcinoma: real-time contrast-enhanced ultrasound findings. Xu ZF1, Xu HX, Xie XY, Liu GJ, Zheng YL, Liang JY, Lu MD. Abdom Imaging. 2010 Dec;35(6):750-6. doi: 10.1007/s00261-009-9583-y.
 
Technical Details Case performed with the GE LOGIQ E9 system.
 
Follow Up Histological examination (performed before cryoablation) demonstrated mucinous tubular and spindle cell carcinoma. 
 
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