Renal Mass

This week's Image of the Week is brought to us Dr. Ciardiulli and Dr. Vasantharam. While performing a bedside Renal US exam on a male patient with L sided flank pain, they appropriately noted a significant abnormality in the LUQ view.

Probe placement for this image of the LUQ is identical to that used for the FAST exam.

Using the curvilinear probe, with the indicator toward the head, the probe is placed in the L posterior axillary line. From this position, subtle fanning of the probe permits complete visualization of the kidney parenchyma, including evaluation for hydronephrosis.

Looking back at the ultrasound image, there is no hydronephrosis noted; however, you see a large amorphous structure on the left superior aspect of the left kidney. The appearance is concerning for a renal mass – particularly Renal Cell Carcinoma. As a result of the irregularity on the ultrasound, a CT scan of abdomen was obtained which further confirmed the mass seen on US.

This patient was admitted for further work-up and is currently awaiting tissue confirmation of what is suspected to be RCC.

This case illustrates the importance of recognizing abnormals – both in terms of what we are commonly looking for on bedside renal ultrasound (hydronephrosis if concerned for nephrolithiasis / obstructing stone) as well as obvious tissue abnormalities like the case presented here.