Diagnostic Ultrasound - Abdomen and Pelvis

Upper Tract Urothelial Carcinoma
Diagnoses: Urinary Tract
TERMINOLOGY
• Malignant tumor of transitional epithelium extending from
calyces to ureteral orifices
IMAGING
• Hypovascular infiltrative tumor with minimal enhancement;
lack of vascularity does not exclude TCC
• Typically causes hydronephrosis and calyceal dilatation
• Diffusely infiltrating renal mass with preservation of the
renal contour
• CT/CTU superior to excretory urography or ultrasound
• MRU: Alternative to CTU in patients with iodinated contrast
allergy
TOP DIFFERENTIAL DIAGNOSES
• Renal cell carcinoma (RCC)
• Blood clot or hemonephrosis
• Urothelial thickening
KEY FACTS
PATHOLOGY
• Renal pelvis: 8%, ureter: 2%
• Hallmark of TCC is multifocality and highest recurrence rate
of any cancer
CLINICAL ISSUES
• Gross or microscopic hematuria (70-80%), flank pain (20-
40%), lumbar mass (10-20%)
• Most common sites of recurrence for upper tract urothelial
carcinoma (UTUC) include bladder (22-47%) and
contralateral collecting system (2-6%)
DIAGNOSTIC CHECKLIST
• Important to define location of tumor (renal pelvis, mid
ureter, distal ureter), extent of tumor (intraluminal vs.
extraluminal), ± hydroureteronephrosis, ± invasion into
contiguous organs
• Screen entire excretory system for synchronous tumors
(Left) Graphic shows a
multifocal TCC involving the
upper pole calyces and the
proximal ureter.
Hydronephrosis ± hydrocalyces
are commonly associated with
upper tract TCC. (Right)
Longitudinal ultrasound of the
left kidney shows dilated
calyces st and cortical loss ſt
secondary to a poorly defined
hyperechoic mass in the renal
pelvis . The patient had liver
metastases from this upper
tract urothelial cancer.
(Left) Longitudinal ultrasound
shows the left kidney in a 45-
year-old woman with liver
failure from metastatic
urothelial cancer. Lung and
bone metastases were also
present. The kidney is enlarged
and hydronephrotic. A
lobulated/papillary
hyperechoic mass extends
from the renal pelvis into
calyces. (Right) Longitudinal
ultrasound of the right kidney
shows lower pole
hydronephrosis ſt. The sinus
fat in the upper 1/2 of the
kidney is infiltrated by
indistinct urothelial cancer .
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