79-year-old man presented with abdominal pain

 

Images

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afarin Sadeghian

 

Case Section

Uroradiology & Genital Male Imaging

 

Patient's Information

Gender : Male
Age : 79

 

Clinical Summary

79-year-old man presented with abdominal pain

 

Imaging Findings

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.

 

Differential Diagnosis

1.Renal/perirenal lipoma or liposarcoma,2.Wilms tumor,3.Renal cell carcinoma

 

Final Diagnosis

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.

 

References

AJR 151:497-501, September 1988

 

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