34 Perinephric Mass on Computed Tomography and

Magnetic Resonance Imaging

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GU 34-1 Renal cell carcinoma. Contrast CT scan demonstrates a large heterogeneous and necrotic mass (asterisk) invading the perinephric space. Significant thickening of the renal fascia is also seen.39

Fig GU 34-2 Non-Hodgkin's lymphoma. Contrast CT scan shows bilateral perinephric (arrows) and right peripelvic (asterisk) masses.39

• Fig GU 34-3 Retroperiotoneal liposarcoma. Contrast CT scan shows a large heterogeneous, predominantly fat-containing mass (arrows) in the right upper quadrant, which invades the perinephric space and renal hilum.39

• Fig GU 34-4 Hematoma. CT in a patient with acute flank pain demonstrates a perirenal hematoma (arrow) originating from a ruptured angiomyolipoma (asterisk).39

• Fig GU 34-5 Urinoma. Delayed contrast CT scan shows excreted contrast material passing from the left renal pelvis (arrow) into a perinephric fluid collection (asterisk), confirming the diagnosis. The patient developed flank pain after aortic aneurysm repair.39

• Fig GU 34-6 Xanthogranulomatous pyelonephritis. Contrast CT scan shows an enlarged right kidney with an abscess-like low-attenuation cavity (asterisk) in the right hilum. The staghorn calculus (arrowhead) was also seen on unenhanced images. The inflammatory process extends to the perinephric space (arrow).39

• Fig GU 34-7 Extramedullary hematopoiesis. Contrast-enhanced CT scan shows a large hypodense, hypervascular mass encasing the right renal hilum and distorting the collecting system (asterisk). There is involvement of the perirenal space bilaterally (arrows). Note the preservation of the contours of the kidneys.39

• Fig GU 34-8 Erdheim-Chester disease. Contrast CT scan shows a left perinephric hypovascular mass (arrow) associated with fat stranding and moderate hydronephrosis (asterisk).39

• Fig GU 34-9 Cortical necrosis. In this patient with acute renal failure following severe antepartum hemorrhage, a contrast CT scan demonstrates a lack of enhancement of the renal cortex (arrow) but normal renal medulla enhancement. Note the slight enhancement of the renal capsule (arrowheads).39

• Fig GU 34-10 Nephroblastomatosis. Contrast CT scan shows bilateral enlargement of the kidneys caused by hypodense, nonenhancing, cortical soft-tissue masses (arrows). Note the distortion of the renal parenchyma centrally.39