Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Resident : Afarin Sadeghian
Uroradiology & Genital Male Imaging
Gender : Male
Age : 79
79-year-old man presented with abdominal pain
Axial CT scan images obtained after IV contrast administration in parenchymal phase (Fig.1-4)demonstrate a well-defined,cortical-based,heterogeneous mass containing areas of fat associated with pathy enhancement arising from lateral aspect of left kidney.Perirenal space shows intermediate-density contents,suggestive of perirenal hematoma which spreads along fascial plane into the posterior pararenal space.Resection of the mass was done.Post operative images included axial CT scan images obtained after IV contrast administration in cortical and delayed phases(Fig.5-9) show wedge-shaped parenchymal defects involve both cortex and medulla and extend to the capsular surface,consistent with renal infarct.Thin rim of cortical enhancement is noted,due to collateral capsular perfusion.
1.Renal/perirenal lipoma or liposarcoma,2.Wilms tumor,3.Renal cell carcinoma
Spontaneous rupture of an angimyolipoma proven at surgery along with iatrogenic occlusion(avulsion) of segmental branch of renal artery produces focal renal infarct
Discussion (Related Text)
Angiomyolipoma of the kidney, also called renal hamartoma, can be diagnosed noninvasively and with great accuracy by modern imaging techniques because fat within these tumors is usually shown readily by sonography and CT. However, some angiomyolipomas contain only tiny amounts of fat that can be easily over looked unless searched for carefully in the CT study. Careful sampling of low- density regions within the mass must be performed, and the use of nonenhanced scans and thin sections (5 mm) will increase the chances of establishing the presence of fat within the tumor.Treatment for symptomatic lesions often is surgical, but renal embolization has also been used, especially to stop acute bleeding . In the past, surgical removal was common because of the inability to distinguish the lesion from renal cell carcinoma.CT of renal cell carcinoma does not reveal islands of fat in the tumor similar to those in angiomyolipoma.
AJR 151:497-501, September 1988