Spectrum of sonographic findings in 125 renal masses other than benign simple cyst

The sonographic findings of 125 renal masses that did not meet the sonographic criteria of benign simple cyst were retrospectively reviewed and correlated with the pathologic diagnosis. Of the 125 masses, 102 were renal cell carcinoma. These carcinomas, two of nine angiomyolipomas, and the 14 other renal masses of various histologic types exhibited a broad spectrum of sonographic findings. Seven of nine angiomyolipomas and the one multiloculated cystic nephroma had a rather characteristic sonographic appearance. With the knowledge of this spectrum of sonographic findings and strict attention to scanning techniques and sonographic criteria, the radiologist should be able to define the characteristics of a variety of renal masses and suggest the correct diagnosis. It should be possible to make the diagnosis of angiomyolipoma confidently if the characteristic sonographic and computed tomographic appearance of these tumors can be demonstrated. In some cases, the correct histologic diagnosis of a renal mass can be made only with biopsy or surgery.     

肾血管平滑肌脂肪瘤的多层螺旋CT诊断

目的:探讨多层螺旋CT在肾血管平滑肌脂肪瘤诊断中的价值。方法:14例肾血管平滑肌脂肪瘤患者行多层螺旋CT扫描检查,并在工作站行MPR、MIP图像重建,分析肾血管平滑肌脂肪瘤的MSCT表现,并与手术病理结果对照。结果:14例肾血管平滑肌脂肪瘤CT平扫肿块均呈等、低、高低混杂密度,11例其中显示有脂肪密度,1例显示高密度出血灶。多期增强扫描皮质期肿块呈均匀或不均匀强化,但低于肾皮髓质强化,脂肪、坏死囊变、出血区无强化,分泌期肿块持续强化。MIP显示肿块内纡曲、增粗的血管。结论:多层螺旋CT能显示肾血管平滑肌脂肪瘤肿块内的脂肪成分及血管成分,多期增强扫描能了解肿块的强化方式,对肾血管平滑肌脂肪瘤的诊断具有重要价值。     

Angiomyolipoma arising in the renal sinus: a difficult radiologic diagnosis

We report a case of angiomyolipoma (AML) occurring in the renal sinus evaluated by intravenous urography (IVU), renal ultrasound (US), angiography, and computed tomography (CT). Imaging features of this lesion are identical to AMLs elsewhere, but preoperative diagnosis was complicated by the unusual occurrence of the tumor in this location in a patient with abdominal pain. Accurate preoperative diagnosis will allow tumorectomy or conservative management.     

Angiomyolipoma arising in the renal sinus: A difficult radiologic diagnosis

We report a case of angiomyolipoma (AML) occurring in the renal sinus evaluated by intravenous urography (IVU), renal ultrasound (US), angiography, and computed tomography (CT). Imaging features of this lesion are identical to AMLs elsewhere, but preoperative diagnosis was complicated by the unusual occurrence of the tumor in this location in a patient with abdominal pain. Accurate preoperative diagnosis will allow tumorectomy or conservative management.     

Retroperitoneal fibrosis: ultrasound and CT features.

The sonographic and computed tomographic (CT) findings in three cases of retroperitoneal fibrosis are illustrated. Its clinical, laboratory, and conventional radiographic findings are often nonspecific. The sonographic findings consist of an extensive retroperitoneal, extrarenal, anechoic, well marginated, and irregularly contoured mass. Computed tomography depicts a paraspinal, extrarenal, and well marginated lesion that is isodense with the surrounding muscles. Through other abnormalities present similar sonographic and CT findings, the differential diagnosis is limited so that correlation of the clinical and radiographic changes allows a preoperative diagnosis with high confidence.     

Aggressive renal angiomyolipoma extending into the renal vein and inferior vena cava - an uncommon entity

Renal angiomyolipoma is recognised as a benign hamartomatous lesion with no obvious malignant potential. However, the tumour may show extrarenal/perinephric extension at times. Rarely, the lesion may extend into the renal vein and inferior vena cava (IVC) indicating aggressive behaviour. We present a case of an angiomyolipoma of the kidney with sonographic, CT and MRI evidence of extension into the renal vein and IVC.     

Ultrasound evaluation of renal parenchymal disease and hydronephrosis

The ultrasonic findings in renal disease are reviewed and a differential diagnosis is formulated for each sonographic abnormality. Lesions can be characterized by their location and sonographic texture. The sonographic findings combined with the clinical history may lead to a specific diagnosis or be useful in determining the next imaging study that should be obtained.     

Angiomyolipoma of the liver

The radiological features of a case of angiomyolipoma of the liver are reported. A review of the literature has shown this to be a rare benign tumour. The lesion falls within the broad spectrum of lipomatous liver tumours. The angiomyolipoma was shown to be a well defined, fat-density mass on computed tomography. The mass was echogenic, with a sharp margin, on ultrasound. Angiography showed the lesion to be vascular. The preoperative diagnosis of a lipomatous tumour was therefore possible.     

Renal angiomyolipoma: typical and atypical features

Renal angiomyolipoma is an uncommon lesion, well-known to the radiologists as one of the few lesions for which a specific diagnosis can be achieved on the basis of radiological findings. It contains variable amounts of adipose tissue, smooth muscle and vessels. It usually grows as single lesion, and it can be isolated or associated with tuberous sclerosis or with the more rare lymphangioleiomyomatosis. From a radiological point of view there are typical aspects that allow a confident diagnosis, whereas more rarely there are atypical aspects that make the diagnosis more controversial. In this review the clinical, macro and microscopic morphological aspects of angiomyolipoma are presented as well as the therapeutic approaches that can be adopted in different circumstances. The most frequent and the atypical characteristics that can be appreciated with diagnostic imaging are described as well.     

肾脏上皮样血管平滑肌脂肪瘤的CT诊断

目的 探讨肾脏上皮样血管平滑肌脂肪瘤(EAML)的CT表现,以提高对该病的诊断水平.方法 对15例经手术病理证实为肾脏EAML的临床及影像资料进行回顾性分析.15例肾脏EAML均经CT平扫及增强扫描.结果 肾EAML具有一定的特征性表现:(1)CT平扫呈稍低或等高密度,无脂肪成分,边界光整,圆形或类圆形,直径为2～5 cm;(2)病灶可以累及肾髓质部分或向外生长,但实验室检查无血尿;(3)增强扫描动脉期呈明显或较明显均匀强化,少数可不均匀明显强化,部分病灶内有增粗迂曲的血管;(4)强化方式为快进快出.结论 CT特征表现对正确诊断肾脏EAML有重要价值.     

Epinephrine enhanced renal angiography in the diagnosis of hamartoma (angiomyolipoma): a reevaluation.

The vlue of epinephrine enhanced angiography in the preoperative distinction of isolated hamartoma (angiomyolipoma without stigma of tuberous sclerosis) from hypernephroma has been largely discounted in the past. The authors performed this procedure in 6 patients (4 with isolated hamartoma and 2 with tuberous sclerosis complex). Vasoconstriction of the tumor vessels in the isolated group suggested the benign nature of the hypervascular mass in all cases. Vasoconstriction stronger than that of normal parenchymal vessels suggested the diagnosis of isolated renal angiomyolipoma. This form of pharmacoangiography should be part of the routine preoperative workup of all solid renal masses.     

MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌鉴别诊断价值

目的探讨MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌的鉴别诊断价值。方法选取经临床病理证实的并有完整临床和CT资料的21例乏脂肪RAML与14例嫌色细胞肾癌,回顾性分析其MSCT表现,测量病灶的各期CT值,并测量病灶相同层面皮质的CT值,并计算病灶CT值与其邻近皮质CT值的比值,统计分析各期CT值及其比值的统计学差异。结果乏脂肪RAML 21例,嫌色细胞肾癌14例,乏脂肪RAML呈等高密度影16例,嫌色细胞肾癌呈等高密度10例;乏脂肪RAML与嫌色细胞肾癌在平扫、皮质期、髓质期及分泌期CT值以及平扫、髓质期病灶与相近皮质比值均差异有明显统计学意义(P<0.05),皮质期及分泌期病灶与邻近皮质比值差异无统计学意义(P>0.05),皮质期ROC曲线下面积最大(0.871),当皮质期CT值选择为106 HU时,鉴别RAML和ThRCC的敏感度为74%,特异性为91%,Youden指数为0.66。结论MSCT动态增强在乏脂肪RAML与嫌色细胞肾癌鉴别中具有一定的价值,特别是皮质期的病灶CT值具有良好的鉴别诊断价值。     

肾错构瘤合并结节性硬化的诊断与治疗(4例报告与文献复习)

目的　进一步提高对肾错构瘤合并结节性硬化的诊断和治疗水平。方法　对 4例肾错构瘤合并结节性硬化患者的临床资料和随访情况进行回顾性分析。结果　4例肾错构瘤合并结节性硬化患者均行手术治疗,术后病理结果明确诊断,术后定期复查B超,平均随访 30个月,均无复发。结论　肾错构瘤合并结节性硬化的患者多为双侧多发性病变,如一定要行手术治疗应慎重,必须要考虑肾功能的保留问题,肾部分切除和或选择性肾动脉栓塞术为首选。     

Large renal leiomyoma: A multidisciplinary approach to diagnosis

We report the case of a 45-year-old woman who presented with a large palpable abdominal mass. Initial sonographic and computed tomographic studies prompted a differential diagnosis of retroperitoneal or renal sarcoma, leiomyoma, and lipid-poor angiomyolipoma. A final diagnosis of renal leiomyoma was reached based on a consensus among radiology, surgery and pathology. In addition to reviewing the features of this entity, this case demonstrates the process of developing a working diagnosis, narrowing the differential as zadditional testing is performed and establishing a final diagnosis with interdepartmental coordination. Despite the rarity of this condition, the ability to recognize and apply imaging features to differentiate between abdominal masses of unknown origin is important for clinicians and researchers.     

巨大肾血管平滑肌脂肪瘤自发性破裂大出血CT误诊4例分析

目的：探讨肾血管平滑肌脂肪瘤破裂出血手术前误诊的原因及CT手术前诊断该病的可能性。方法：复习手术与病理证实的4例术前CT误诊的巨大的肾血管平滑肌脂肪瘤伴破裂出血的病例。结果：巨大的肾血管平滑肌脂肪瘤可发生肿瘤内、肾筋膜囊内,盆腔膜后甚至腹腔内出血;仔细寻找肿块内代表脂肪成分的CT征是支持肾血管平滑肌脂肪瘤诊断的关键。误诊原因可能 与出血掩盖肿块内实际存在的脂肪征有关,也可能与将被挤到肿块的边缘的肿瘤内的脂肪结构误诊为肾筋膜囊内或肾窦内的脂肪有关,结论：巨大的肾血管平滑肌脂肪瘤可发生自发性破裂出血,手术前CT发现肿块内脂肪征是诊断的关键。     

合并出血的肾血管平滑肌脂肪瘤的多层螺旋CT诊断

目的：提高对合并出血的肾血管平滑肌脂肪瘤的诊断准确率。方法：回顾性分析13例经手术病理证实为肾血管平滑肌脂肪瘤合并出血的患者CT资料,观察其影像学表现。结果：发生于左肾者8例,右肾者4例,1例为双侧者。病灶最大者达25 cm,最小者约3 cm。所有病灶内均可见出血,部分合并肾包膜下或肾周出血。增强后病灶内脂肪成分及出血无强化,实性成分可见轻至中度强化。所有病灶内均可见血管影。4例病灶突破肾包膜,2例同时合并肾周感染。结论：多层螺旋CT尤其是增强检查,对合并出血的肾血管平滑肌脂肪瘤的诊断极有价值。     

Various radiological appearances of angiomyolipoinas in the same kidney

A 21-year-old woman with tuberous sclerosis presented with abdominal distension and flank pain. Imaging studies, including CT and MR imaging, revealed bilateral renal mass lesions, containing fat and suggesting the diagnosis of tuberous sclerosis. However the imaging characteristics of one of these lesions differed from the others with no radiologically detectable fat tissue in this solid lesion suggesting renal cell carcinoma. Histopathological examination of this lesion in the left kidney revealed an angiomyolipoma with minimal fat tissue. The radiological diagnosis of angiomyolipomas with minimal fat tissue remains difficult and the differential diagnosis is discussed. Received: 5 October 1998; Revised: 22 December 1998; Accepted: 7 June 1999     

Echotomography-computerized tomography integration in the tissue characterization of renal angiomyolipoma

A sonographic and a computed tomographic study of 29 patients was performed in order to assess the possibilities of these imaging techniques in tissue characterization of renal angiomyolipoma. From the review of the results the authors, confirming the very high accuracy of the two associated methods for a correct diagnosis, underline the possibility to identify the hamartoma mesenchymal components with the possibility of more prognostic and therapeutic informations.     

超声诊断肾细胞癌的价值并与CT对照

目的:评价彩色多普勒超声及灰阶超声诊断肾细胞癌的价值.材料和方法:回顾性分析31例手术病理证实为肾细胞癌的肾脏肿瘤的超声表现及超声定性诊断,并与CT诊断对比.结果:超声定性诊断与术后病理符合率83.9%(26/31),彩色多普勒超声表现为抱球型和丰富血流型的肾脏肿瘤,术前均定性诊断正确(21/21).而对于少血流型肿瘤,均未提出正确的定性诊断.超声及CT对于肾细胞癌定性诊断的符合率无差异(P＞0.05).结论:超声诊断肾细胞癌有很高的价值,尤其对血供丰富的肾肿瘤意义更大,可作为肾细胞癌患者术前首选检查方法.     

Giant angiomyolipoma with atypical arteriovenous shunting: CT and angiographic studies

The advent of both ultrasound and computerized tomography made the pre-operative diagnosis of angiomyolipoma much easier. However, differentiation from retroperitoneal, perinephric space and especially intrarenal liposarcoma remains difficult or impossible. Angiographic findings are atypical and often do not allow differentiation from renal cell carcinoma. Early filling of the renal vein in renal cell carcinoma is sometimes used to distinguish renal cell carcinoma from angiomyolipoma. A case of a giant angiomyolipoma with arteriovenous shunting and early filling of the renal vein is described.