Left renal mass and left flank pain. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology signal intensity and enhancement. No focal liver lesion. No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: Spleen is normal in size measuring 12.5 cm in length without a focal lesion.PANCREAS: The pancreas is normal in morphology and enhancement without evidence of a focal lesion to suggest metastatic disease. It is displaced anteriorly by the left renal mass.ADRENAL GLANDS: The adrenal glands are normal in morphology, signal intensity and enhancement.KIDNEYS, URETERS: There is a large multilobulated mass infiltrating and expanding the left kidney measuring up to 10.4 x 10.5 x 12.7 cm (series 801/23 and series 701/21). The lesion at least abuts the adjacent perinephric fat. It demonstrates low T2-weighted signal intensity and heterogeneous postcontrast enhancement less intense than the renal cortex with regions of nonenhancement/necrosis. There are enlarged perirenal vessels. The mass has extensive involvement of the collecting system with obstructed dilatation of the superior and inferior collecting system.The left renal vein does not appear to be involved with tumor thrombus. It is displaced anteriorly by the extensive necrotic retroperitoneal lymphadenopathy.RETROPERITONEUM, LYMPH NODES: Extensive necrotic retroperitoneal lymphadenopathy. Retrocrural lymphadenopathy. Left supraclavicular and mediastinal lymphadenopathy noted on outside hospital CT. The lymphadenopathy elevates the abdominal aorta and displaces the pancreas anteriorly as well as the left renal vein. Lymphadenopathy encases the left renal artery which is opacified. For future reference the anterior left periaortic lymph node measures 3.9 x 3.4 cm (series 1 304/164).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Small pleural effusions.
Very large partially necrotic left renal mass expanding and infiltrating the left kidney with extensive associated retroperitoneal and retrocrural lymphadenopathy. Left supraclavicular and mediastinal lymphadenopathy noted on outside CT. The imaging characteristics of the lesion are not that of a conventional clear cell carcinoma. An atypical lesion specifically a collecting duct carcinoma or other neoplasm of the renal medulla is suspected.