EURORAD ESR

Case 13685

Giant, sporadic, multicentric, locally aggressive, renal angiomyolipoma, complicated by emphysematous pyelonephritis, psuedoaneurysm and Wunderlich syndrome

Author(s)
Dr. Anjana Trivedi1, Dr. Anirudh Chawla2, Dr. Jagruti Kalola1, Dr. Chetna Dodia3

(1) MD Radiology
(2) Resident, MD Radiology
(3) DMRD
Civil Hospital, P.D.U. Medical College;
Jamnagar Road 360001
Rajkot, India;
Email:anirudhchawla@gmail.com
 
Patient
female, 35 year(s)
 
 
  • Figure 1
    Ultrasound panoramic view of left renal lesion

    Ultrasound panoramic view of left renal lesion showing a 22 x 11 cm mixed echogenic mass lesion with internal hyperechoic fat and areas of necrosis/collection.

     
    Area of Interest: Abdomen; Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 2
    Ultrasound of left renal lesion

    Ultrasound image shows a large mass lesion arising from upper and mid polar region of left kidney. Mild perinephric collection is noted.

     
    Area of Interest: Kidney; Oncology; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage; Neoplasia;
     
     
  • Figure 3
    High resolution ultrasound of lesion

    High resolution ultrasound (9MHz) of lesion shows myomatous component in the lesion resembling the superficial rectus muscle. The lesion shows internal hyperechoic area suggestive of fat. Area of haemorrhage/necrosis...

     
    Area of Interest: Abdomen; Kidney; Oncology; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage; Neoplasia;
     
     
  • Figure 4
    High resolution ultrasound of lower pole of kidney

    High resolution ultrasound (9Mhz) of lower pole of left kidney shows multiple geographic hyperechoic lesions in lower pole suggestive of multiple angiomyolipomas.

     
    Area of Interest: Abdomen; Kidney; Oncology; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 5
    CECT sagittal section through left renal lesion

    Large mass lesion is seen arising from upper and mid polar region of left kidney. The lesion shows enhancing soft tissue component, hypodense fat component and internal air foci. Mild hyperdense free fluid is noted.

     
    Area of Interest: Abdomen; Kidney; Oncology; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Contrast agent-oral; Diagnostic procedure; Special Focus: Haemorrhage; Neoplasia;
     
     
  • Figure 6
    CECT axial view

    Large mass lesion with enhancing soft tissue and fat component is noted arising from left kidney. The lesion shows internal air foci. Hyperdense free fluid is seen in Morrison's pouch.

     
    Area of Interest: Kidney; Oncology; Imaging Technique: CT; Procedure: Contrast agent-intravenous; Diagnostic procedure; Special Focus: Neoplasia;
     
     
  • Figure 7
    CECT sagittal sections through left renal lesion
     

    CECT sagittal section through the lesion shows pooling of intravenous contrast within the lesion suggestive of pseudo-aneurysm formation.

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

    CECT sagittal section through the lesion shows pooling of intravenous contrast within the lesion suggestive of pseudo-aneurysm formation.

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

    Corresponding axial ultrasound image shows the pseudo-aneurysm as a collection with internal echoes.

     
    Area of Interest: Abdomen; Kidney; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Aneurysms;
     
     
Ultrasound panoramic view of left renal lesion showing a 22 x 11 cm mixed echogenic mass lesion with internal hyperechoic fat and areas of necrosis/collection.
 
Ultrasound image shows a large mass lesion arising from upper and mid polar region of left kidney. Mild perinephric collection is noted.
 
High resolution ultrasound (9MHz) of lesion shows myomatous component in the lesion resembling the superficial rectus muscle. The lesion shows internal hyperechoic area suggestive of fat. Area of haemorrhage/necrosis is noted.
 
High resolution ultrasound (9Mhz) of lower pole of left kidney shows multiple geographic hyperechoic lesions in lower pole suggestive of multiple angiomyolipomas.
 
Large mass lesion is seen arising from upper and mid polar region of left kidney. The lesion shows enhancing soft tissue component, hypodense fat component and internal air foci. Mild hyperdense free fluid is noted.
 
Large mass lesion with enhancing soft tissue and fat component is noted arising from left kidney. The lesion shows internal air foci. Hyperdense free fluid is seen in Morrison's pouch.
 
CECT sagittal section through the lesion shows pooling of intravenous contrast within the lesion suggestive of pseudo-aneurysm formation.
 
CECT sagittal section through the lesion shows pooling of intravenous contrast within the lesion suggestive of pseudo-aneurysm formation.
 
Corresponding axial ultrasound image shows the pseudo-aneurysm as a collection with internal echoes.
 
 
 
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