Reason: evaluate changes to angiomyolipomas History: tuberous sclerosis on Afinitor EXAMINATION: MR renal protocol with and without contrast. ABDOMEN:LIVER, BILIARY TRACT: Large stone is again seen in the gallbladder neck, without significant interval change. There is mild dilatation of the common bile duct but no evidence of acute cholecystitis. Hepatic signal is within normal limits. No focal lesion liver lesions are identified.SPLEEN: Normal appearance of the spleen.PANCREAS: No pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple lesions are again seen throughout both kidneys, many of which represent simple and mildly complex cysts, some with evidence of previous hemorrhage. The largest lesion is a partially exophytic cystic structure in the lower pole of the right kidney, which measures up to 2.8 cm in diameter, previously 2.4 cm, slightly increased from the previous study (series 6, image 10).The reference partially exophytic lesion in the midpole of the left kidney currently measures 1.4 x 1.2 cm, previously 1.8 x 1.3 cm (series 6, image 18). This lesion is heterogeneous on T2 without microscopic fat on out of phase imaging or enhancement, as seen previously.The lesion slightly more inferior to this reference lesion in the mid/lower pole of the left kidney measures 1.6 x 0.9 cm, previously 1.8 x 1.3 cm, slightly decreased in size (series 6, image 14). This lesion also demonstrates heterogeneous signal on T2 weighted imaging as well as dropout on out of phase imaging, indicating microscopic fat, the lesion does not enhance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY:No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Reference lesion in the left kidney is slightly decreased when compared to the prior study. The lesion does not demonstrate enhancement or microscopic fat. Continued follow-up is recommended.2.Slight interval decrease in size in the angiomyolipoma of the mid/inferior pole of the left kidney.3.Multiple additional bilateral renal cysts, some of which demonstrate evidence of previous hemorrhage, are again seen, the largest of which in the right lower pole is slightly increased in size when compared to the prior study.4.Cholelithiasis without acute cholecystitis.