EURORAD ESR

Case 10917

Recurrent Wilms' tumour in a young girl: a case report

Author(s)
Iodice V, Rossi P, Tarantini G, Raffo L, Sarti E

Diagnostic and Interventional Radiology,
University of Pisa,
Via Roma 67,
56125 Pisa, Italy
 
Patient
female, 18 year(s)
 
 
  • Figure 1
    First CT that reveals a relapse of Wilms tumour
     

    The biggest masses with upper hydric density and poorly enhanced (arterial phase): below the liver, below the Glisson's capsule and at the VI liver segment.

     
    Area of Interest: Abdomen; Kidney; Liver; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    With contrast during portal phase the mass is heterogeneous.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    CT images with contrast enhancement during arterial and venous phase: mass at a lower level of the previous images.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    CT images with contrast enhancement during arterial and venous phase: mass at a lower level of the previous images. Notice the previous right nephrectomy.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    Other masses in iliac fossa, in front of the bladder, between the bladder and the uterus.

     
    Area of Interest: Oncology; Pelvis; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    CT control after two months of chemotherapy
     

    Reduction of the masses near the liver

     
    Area of Interest: Abdomen; Kidney; Liver; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    CT image with contrast enhancement (CE) during venous phase: The masses have a heterogeneous CE

     
    Area of Interest: Oncology; Paediatric; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Treatment effects; Special Focus: Neoplasia;

    CT images with CE during arterial and portal phase: mass at a lower level of the previous image.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    A new big mass in the pelvis with internal thin septi. This mass shifts the uterus ahead and to the right, and the bladder down.

     
    Area of Interest: Genital / Reproductive system female; Oncology; Pelvis; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 3
    MRI to complete the study of the pelvic mass
     

    T2-wt sagittal image shows pelvic cystic mass with many internal septi, that shifts the uterus to the right, the bladder ahead and the rectum back and above.

     
    Area of Interest: Oncology; Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    T2-wt coronal and sagittal images, that show the craniocaudal and anteroposterior diameters of the lesion

     
    Area of Interest: Oncology; Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts;

    T2-wt axial images at two different levels, showing dislocation of the near organs by the cystic mass

     
    Area of Interest: Oncology; Paediatric; Pelvis; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Cysts; Neoplasia;
     
     
  • Figure 4
    First CT after the surgery of all the masses
     

    A fluid mass below the liver whose walls are enhanced, that is like an "hourglass" and with some air bubbles.

     
    Area of Interest: Abdomen; Liver; Oncology; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    Coronal MPR image of the abdomen, showing remaining lesions

     
    Area of Interest: Abdomen; Kidney; Liver; Imaging Technique: CT; Image manipulation / Reconstruction; Procedure: Computer Applications-3D; Contrast agent-intravenous; Special Focus: Neoplasia;

    MPR sagittal image showing remaining mass under the liver.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;

    MPR sagittal image, showing pelvic recurrence of disease with its extension

     
    Area of Interest: Oncology; Paediatric; Pelvis; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Neoplasia;

    Oblique CT reconstruction, showing recurrence of disease near the last rib.

     
    Area of Interest: Abdomen; Oncology; Paediatric; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Metastases;
     
     
  • Figure 5
    CT control after 6 months of chemotherapy

    A new mass in the lower rectum muscle.

     
    Area of Interest: Abdominal wall; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;
     
     
The biggest masses with upper hydric density and poorly enhanced (arterial phase): below the liver, below the Glisson's capsule and at the VI liver segment.
 
With contrast during portal phase the mass is heterogeneous.
 
CT images with contrast enhancement during arterial and venous phase: mass at a lower level of the previous images.
 
CT images with contrast enhancement during arterial and venous phase: mass at a lower level of the previous images. Notice the previous right nephrectomy.
 
Other masses in iliac fossa, in front of the bladder, between the bladder and the uterus.
 
Reduction of the masses near the liver
 
CT image with contrast enhancement (CE) during venous phase: The masses have a heterogeneous CE
 
CT images with CE during arterial and portal phase: mass at a lower level of the previous image.
 
A new big mass in the pelvis with internal thin septi. This mass shifts the uterus ahead and to the right, and the bladder down.
 
T2-wt sagittal image shows pelvic cystic mass with many internal septi, that shifts the uterus to the right, the bladder ahead and the rectum back and above.
 
T2-wt coronal and sagittal images, that show the craniocaudal and anteroposterior diameters of the lesion
 
T2-wt axial images at two different levels, showing dislocation of the near organs by the cystic mass
 
A fluid mass below the liver whose walls are enhanced, that is like an "hourglass" and with some air bubbles.
 
Coronal MPR image of the abdomen, showing remaining lesions
 
MPR sagittal image showing remaining mass under the liver.
 
MPR sagittal image, showing pelvic recurrence of disease with its extension
 
Oblique CT reconstruction, showing recurrence of disease near the last rib.
 
A new mass in the lower rectum muscle.
 
 
 
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