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Abdomen » Kidneys/Ureters
Renal Cell Carcinoma CEUS 3
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Presentation

A 62 year old male presented with a history of hypertension, stroke, and hyperlipidemia. A CT scan of the abdomen and pelvis demonstrated an indeterminate enhancing 2.5 cm mass in the lateral right kidney. 

 
 
 
Caption: Image 1: Transverse Right kidney
Description: A transverse ultrasound image demonstrated a solid, hyperechoic lesion within the right kidney.
 
 
 
Caption: Image 2: Transverse kidney
Description: The lesion was approximately 2.3 cm at its greatest width.
 
 
 
Caption: Image 3: Sagittal B-mode ultrasound image of right kidney
Description: A sagittal B-mode ultrasound image through the lateral margin of the right kidney again demonstrated a solid, hyperechoic lesion measuring 2.3 cm.
 
 
 
Caption: Image 4: A dual contrast enhanced ultrasound (CEUS) image with 2D imaging on left and contrast imaging on right.
Description: This image was captured 7 seconds post contrast injection and demonstrated initial enhancement in lesion.
 
 
 
Caption: Image 5: 46 seconds post injection
Description: This CEUS image captured 46 seconds post contrast injection demonstrated hyperenhancement in lesion.
 
 
 
Caption: Image 6: 1:44 minutes post injection
Description: CEUS image captured 1:44 minutes post contrast injection demonstrated continuing enhancement in lesion.
 
 
 
Caption: Image 7: CEUS image captured 5:05 minutes post contrast injection
Description: At 5:05 minutes post injection the lesion demonstrated weak washout compared to the adjacent normal renal tissue.
 
 
Caption: Video clip of CEUS
Description: Video Clip from 05 through 44 seconds demonstrates abnormal arterial-phase hyperenhancement in this hyperechoic, solid lesion.
 
Differential Diagnosis 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 and washout, consistent with renal cell carcinoma.
 
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