56-year-old male with suspicious lesion on native kidney ABDOMEN:LIVER, BILIARY TRACT: Loss of fat plane between the inferior border of the liver and the mass.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral atrophic native kidneys. Large complex heterogeneous masslesion arising from the right native kidney measures 9.6 x 8.7 cm in transaxial plane and 10.2 cm in craniocaudal dimension. Lesion demonstrates extensive T1 hyperintense signal, consistent with hemorrhage or proteinaceous material. Multiple intralesional thin enhancing septations seen. No macroscopic fat is identified in lesion.Additional mildly enhancing mass (T1 isointense and T2 hypointense; see image 30 series 7) arising from the right kidney measuring 1.5 x 1.5 cm, suspicious for small renal cell carcinoma. Intralesional microscopic fat suggested on image 51 series 9. Atrophic left native kidney with exophytic subcentimeter mildly enhancing lesion in the interpolar region measures 7 mm. Additional bilateral T2 hyperintense renal lesions seen consistent with simple cysts.Transplant right iliac fossa kidney is partially imaged. Mild fullness of the visualized calyxes. Superior pole parenchymal scarring.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Large right native kidney masslesion as described above. With application of Bosniak classification, imaging features consistent with a Bosniak 2F lesion.2.Right native kidney exophytic lesion with mild enhancement suspicious for malignancy (given T2 hypointensity and lesser degree of enhancement, especially concerning for papillary subtype). 3.Left native kidney exophytic subcentimeter lesion also showing mild enhancement is concerning for an additional neoplastic focus. 