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Abdomen » Kidneys/Ureters
Wilms tumor (atypical)
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Presentation Ten year old girl with hematuria and fever.
 
 
 
Caption: Sagittal image of the left kidney.
Description: An oval shaped, well defined homogenous solid mass is present in the interpolar region of the left kidney.
 
 
 
Caption: Sagittal image of the left kidney.
Description: An oval shaped, well defined homogenous solid mass is present in the interpolar region of the left kidney.
 
 
 
Caption: Color doppler image, left mid kidney.
Description: Color Doppler shows displaced vessels peripheral to the mass.
 
Differential Diagnosis Benign solid renal tumors: fibroma, angiolipoma, hemangioma of the kidney (rare findings in childhood)
 
Final Diagnosis Wilms tumor.
 
Discussion CT confirmed a solid mass in the left kidney. Intravenous contrast enhanced spiral CT demonstrated minimal contrast enhancement. No necrosis or hemorrhage was present. Following left nephrectomy, the mass was confirmed to be a Wilms tumor histologically.

This case demonstrates an atypical appearance for a Wilms tumor. The most common pediatric renal mass, a Wilms tumor is usually large and heterogeneous on US, CT and MRI. The heterogeneity reflects necrosis, hemorrhage, fat or calcification. However, in this case, the mass was homogeneous.
 
Case References Lowe LH, Isuani BH, Heller Rm et al. Pediatric renal masses: Wilms Tumor and Beyond. Radiographics 2000; 20: 1585-1603.
 
Technical Details GE, Logiq 9, 4-6 MHz convex transducer
 
Follow Up The patient underwent nephrectomy followed by chemotherapy.
 
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