Ultrasound Pictures “Hypernephroma”

Clinical manifestations: Most of these tumors are asymptomatic, and the only
manifestation may be intermittent fever in the absence of infection. Microhematuria is usually present; gross hematuria is rare. An expansile tumor will cause flank pain and a palpable intra-abdominal mass. Metastases are seeded to the lung, CNS, bone, and thyroid gland. Late features include fatigue, weight loss,
and cachexia.

Note: Tumors detected early by ultrasound are surgically curable.

Diagnosis:
x Urinalysis: All patients with hematuria should be evaluated for serious underlying disease. Possible causes are renal, bladder and urinary tract tumors; glomerulonephritis (casts in urinary sediment); and pyelonephritis.
x Sonography
x Intravenous pyelography; abdominal CT if required

Sonographic findings:
x Nonhomogeneous renal mass; may be associated with regressive changes,
intratumoral hemorrhage, or both
x Lesion transcends the renal capsule
x Variable echogenicity relative to the renal parenchyma
x Lesion is well delineated by a pseudocapsule

“Ultrasound Pictures” Large, hypoechoic tumor (T). Partial hypechoic transformation of sinus echo due to tumor vein thrombosis. K = kidney

Accuracy “Ultrasound Pictures” diagnosis: Even small, asymptomatic renal cell carcinomas can be detected at an early stage by routine sonography. Tumors as small as 5mm can be visualized under favorable conditions. In a selective tumor search, renal changes can be reliably detected and referred for further evaluation. The tumor may be mistaken for a cystic lesion on ultrasound, and percutaneous aspiration should be carried out. A cyst contains clear yellowish fluid, whereas a carcinoma yields a turbid, sometimesbloody aspirate that may be cytologically negative.