case studies

Renal Tumour

Patient History
A patient presented with a known renal tumour for assessment of the mass and possible spread.

Methodology
A contrast enhanced CT scan of the abdomen and pelvis was undertaken using 100mls of omnipaque 300 pump injected to enhance the kidneys in arteria1 phase. The scan field was from diaphragms through to symphasis pubis with the possibility of delayed rena1 scans. The patient was hyperventilated 20secs before the scan, the scan performed with spiral acquisition in a single breath hold. Factors: 120kvp 250MA. Field of view 50cm pitch 1. 5 10mm slice thickness. Images reconstructed on u standard algorithm with no sharpness enhancement.

Results
Prior to the CT this patient had a pelvis radiograph showing lytic bony disruption in the right ileum extending to the ischium, with the left inferior pupic ramus destroyed, in line with metestatic disease. An ultrasound scan verifying a 6 x Scm solid mass in the 1ower pole of the left kidney thought to be a primary neoplasm. An isotope bone scan showing rib hotspots, along with the above areas. CT confirmed a 6cm irregular mass in the left kidney with no invasion of left renal vein (Image 1). IVC clear and patent. Destructive metastases are confirmed in pelvis adjacent to acetabulum with the acetabular roof destroyed (fig 2).
On the left side the inferior pubic ramus is completely destroyed associated with a large soft tissue enhancing mass (Image 3). It is concluded that there is extensive bony metastases in pelvis with large left sided hyper-nephroma.

Conclusion
CT not only highlighted the extent and size of the renal tumour, but also shows good detail of the bone destruction induced by the bony metastases. CT is useful for bony imaging as well as soft tissue, an area not so well demonstrated by Ultrasound or MRI.

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