Unspecific cortical lesion on CT scan is confirmed cystic and benign with contrast-enhanced renal ultrasonography. A CT scan is the first choice modality for workup of solid masses in the kidneys. Nevertheless, hemorrhagic cysts can resemble renal cell carcinomas on CT, but they are easily distinguished with Doppler ultrasonography (Doppler US). In renal cell carcinomas, Doppler US often shows vessels with high velocities caused by neovascularization and arteriovenous shunting. Some renal cell carcinomas are hypovascular and not distinguishable with Doppler US. Therefore, renal<unk> s without a Doppler signal, which are not obvious simple cysts on US and CT, should be further investigated with contrast-enhanced ultrasound, as this is more sensitive than both Doppler US and CT for the detection of hypovascular<unk> s. Renal ultrasonography Cortical solid mass, which later was shown to be renal cell carcinoma. Measurement of the solid mass on the US image is illustrated by ‘+’ and a dashed line. Renal cell carcinoma with both cystic and solid components located in the cortex. Measurement of<unk>  on the US image is illustrated by ‘+’ and a dashed line. On renal ultrasonography, a solid renal mass appears in the US exam with internal echoes, without the well-defined, smooth walls seen in cysts, often with Doppler signal, and is frequently malignant or has a high malignant potential. The most common malignant renal parenchymal<unk>  is renal cell carcinoma (RCC), which accounts for 86% of the malignancies in the kidney. RCCs are typically isoechoic and peripherally located in the parenchyma, but can be both hypo- and hyper-echoic and are found centrally in medulla or sinus. The lesions can be multifocal and have cystic elements due to necrosis, calcifications and be multifocal (Figure 8 and Figure 9). RCC is associated with von Hippel–Lindau disease, and with tuberous sclerosis, and US has been recommended as a tool for assessment and follow-up of renal masses in these patients. Classification There are many forms of<unk> s: Malignant (cancerous) incidences and prognoses. Like other cancers, kidney cancer is measured in stages. •Stage 1, the<unk>  has not spread and is localized. This accounts for 65% of cases of kidney cancer and 92.5% of people with stage 1 kidney cancer survive 5 years. •Stage 2 and 3, the<unk>  has grown larger and has spread and started to affect regional tissues and lymph nodes. This stage accounts for 17% of kidney cancers and 69% of people are expected to live 5 years with this progression of kidney cancer. •Stage 4, the<unk>  has spread to a distant organ or lymph node. 16% of kidney cancers are progressed to this stage and of those people, 12% of them are expected to live 5 years. * The most frequent, malignant, primary kidney cancer is renal cell carcinoma (RCC) - which has several subtypes: * Clear cell RCC, an epithelial cell<unk>  of the kidney that accounts for 65-70% of all RCCs. * Papillary RCC, a renal<unk>  that accounts for 10-15% of all RCCs. Males are 1.5 times as likely to develop this type of<unk>  than females. Papillary RCCs, usually lead to a better prognosis than clear cell RCCs unless the<unk>  has metastasized. * Chromophobe RCC, a<unk>  with usually the best outcome of prognosis. It accounts for 5-7% percent of RCCs. * Collecting duct RCC * Mesoblastic nephroma, a congenital<unk>  of the kidney's mesenchyme (i.e. connective tissue cells) detected prenatally or, more typically, during the first <4 years of life. * Metastatic<unk> , e.g. ovarian carcinoma. Benign * Renal oncocytoma * Cystic nephroma * Angiomyolipoma * Metanephric adenoma * Renal medullary fibroma Surgical complexity The RENAL Nephrometry Scoring System is used to measure the complexity of<unk> s for determining whether a renal mass is appropriate for partial or radical nephrectomy, and is estimated by CT scan as follows: The nephrometery score takes into account the size of the<unk>  (Radius), how much of the<unk>  is inside or outside of the kidney (Endophytic/Exophytic), how close the<unk>  is to the urinary collecting system (Nearness), whether the mass is on the anterior or posterior surface of the kidney (Anterior), location relative to polar lines(Lines), and whether or not it is touching the renal artery or vein. This system is used mainly to determine appropriateness of performing a partial nephrectomy where only the<unk>  itself is removed, or a radical nephrectomy. Another factor affecting complexity includes renal vein thrombus, which can extend into the inferior vena cava and into the right atrium. The degree of extension is commonly graded as follows: At level 0, the thrombus extends to the renal vein only; at level I, the neoplastic emboli extends into the IVC to no more than 2 cm above the renal vein; at level II, the thrombus reaches into the IVC to more than 2 cm above the renal vein but not to the hepatic vein; moreover at level III, the thrombus reaches into the IVC above the hepatic veins but not above the diaphragm; and finally at level IV, the thrombus extends into the supradiaphragmatic IVC or the right atrium.
Kidney tumour
Renal cyst
Kidney cancer
Liver tumor
Ureteral cancer
Pyonephrosis
Hydronephrosis
Kidney stone disease