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Abdomen » Kidneys/Ureters
Renal Cell Carcinoma CEUS 2
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Presentation A 83 year old female presented with a history of chronic kidney disease, hypertension, and prior breast cancer. A stable 1.2 cm indeterminate lesion in the mid left kidney was identified on ultrasound. 
 
 
 
Caption: Image 1: Transverse Left Kidney
Description: A transverse B-mode ultrasound image demonstrated a hypoechoic lesion in the left kidney.
 
 
 
Caption: Image 2: Transverse Left Kidney
Description: A transverse B-mode ultrasound image demonstrated a hypoechoic lesion in the left kidney measuring 1.4 cm.
 
 
 
Caption: Image 3: A dual contrast enhanced ultrasound (CEUS) image with 2D imaging on left and contrast imaging on right.
Description: This image was captured 15 seconds post contrast injection and demonstrated initial arterial-phase hyperenhancement in the lesion.
 
 
 
Caption: Image 4: A dual contrast enhanced ultrasound (CEUS) image with 2D imaging on left and contrast imaging on right.
Description: CEUS image captured 42 seconds post contrast injection demonstrating enhancement in the lesion with thickened walls.
 
 
 
Caption: Image 5
Description: CEUS image captured 1:49 minutes post contrast injection continued to demonstrate abnormal enhancement within the lesion.
 
 
 
Caption: Image 6
Description: CEUS image captured 3:46 minutes post contrast injection demonstrated washout within the lesion.
 
 
Caption: Video clip: Dual display with 2D imaging on left and contrast imaging on right.
Description: The video clip demonstrates abnormal arterial-phase hyperenhancement and thickened walls in the lesion and washout in the venous phase.
 
Differential Diagnosis Complicated Cyst
Renal Cell Carcinoma
Angiomyolipoma
Oncocytoma
Metastasis
Lymphoma
Renal adenoma
 
Final Diagnosis Renal Cell Carcinoma
 
Discussion

On the CEUS examination, a 2.3 cm solid lesion was visualized with arterial phase hyper-enhancement in thickened walls of the lesion with heterogeneous enhancement of internal mass components. Follow-up CT examination demonstrated a similar enhancement pattern, 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.
 
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