Case of the Day: Kidney- What is that Mass?

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Case Title: Kidney- What is that Mass?
Patient History: 63y/o female referred for a liver ultrasound. Incidental finding of a RT renal Mass
Thanks to:
Dr Stephanie R. Wilson
Christina Merrill
University of Calgary

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IMAGE DESCRIPTION: Axial and Sagittal greyscale Images of the RT kidney showing a well-defined hyperechoic mass.
QUESTION: What do you think this is?

AML

RCC

Can't tell

Teaching Point: Although the most likely diagnosis for a well-defined hyperechoic kidney mass is Angiomyolipoma, in rare cases these can also be Renal Cell Carcinoma.

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IMAGE DESCRIPTION: A movie of the RT kidney showing Washin of a microbubble contrast agent focusing on the mass (arrow). There are residual bubbles from a previous injection at the beginning of the scan.
QUESTION: What are the observations in the Arterial Phase?

Hyperenhancement of the kidney mass

Hypoenhancement of the kidney mass

Isoenhancement of the kidney mass

Teaching Point: Although Renal Cell carcinoma most often has Hyperenhancement in the Arterial Phase, both Papillary Carcinomas and Angiomyolipoma are generally Hypoenhancing

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IMAGE DESCRIPTION: A CEUS image of the RT Kid at 2min, shows similar relative enhancement of the mass to the kidney as in the Arterial Phase image, ie. hypoenhancement.
QUESTION: What is your diagnosis?

AML

RCC

Can't tell

Teaching Point: We use all aspects of the scan. A highly echogenic mass on greyscale with mild APHE on CEUS and no Washout is typical for inconsequential Angiomyolipoma!!
If this is found incidentally a quick CEUS will make the diagnosis avoiding CT and MR scan to look for Fat in the lesion. Avoiding unnecessary downstream testing

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