Diagnostic Ultrasound - Abdomen and Pelvis
Solid Renal Mass Renal Lymphoma Renal Leukemia and Myeloma (Left) Longitudinal ultrasound of the kidney demonstrates a very hypoechoic central lesion ſt with focal calyceal dilatation st. Lymphoma may have a pseudocystic appearance as in this case. (Right) Longitudinal ultrasound shows hypoechoic enlargement of the upper pole of the kidney ſt from myeloma. The renal sinus fat is still discrete st but likely involved. Differential Diagnoses: Kidney Other Renal Tumors Other Renal Tumors (Left) Longitudinal ultrasound shows a large, solid lower pole renal mass , which is hyperechoic to normal kidney ſt. Given its size, nephrectomy was performed. (Right) Axial CECT of the same patient shows a large, enhancing, solid renal mass st with a central scar ſt classic for oncocytoma. Renal Sinus/Replacement Lipomatosis Renal Sinus/Replacement Lipomatosis (Left) Longitudinal ultrasound of the renal fossa reveals no normal kidney. There is a large shadowing stone surrounded by soft tissue of intermediate echogenicity st. (Right) Axial CECT of the same patient confirms a staghorn calculus surrounded by fat st. There is barely any residual renal parenchyma ſt. 971
Renal Pseudotumor Differential Diagnoses: Kidney DIFFERENTIAL DIAGNOSIS Common • Column of Bertin • Renal Junction Line, Junctional Parenchymal Defect • Fetal Lobulation • Dromedary Hump • Hypertrophy Next to Scar • Focal Pyelonephritis/Abscess Less Common • Crossed Fused Ectopia • Hematoma • Arteriovenous Malformation • Focal Xanthogranulomatous Pyelonephritis • Extramedullary Hematopoiesis • Splenorenal Fusion ESSENTIAL INFORMATION Key Differential Diagnosis Issues • Differentiate pseudotumors composed of normal variants from nonneoplastic lesions mimicking renal masses • Note typical locations of normal variant pseudotumors • Rare to have mass effect or distortion of normal architecture/vessels Helpful Clues for Common Diagnoses • Column of Bertin ○ Isoechoic, continuous with renal cortex, normal renal outline ○ No abnormal vascularity on color Doppler ○ Junction of upper and middle 1/3 of kidney ○ Changing sonographic window may clarify nature • Renal Junction Line, Junctional Parenchymal Defect ○ Echogenic line at anterosuperior aspect of kidney without disruption of renal contour or cortical loss ○ Junction of upper and middle 1/3 of kidney and right side most common location ○ Junctional parenchymal defect: Triangular echogenic defect in renal cortex, upper to mid 1/3 ○ Cine clips are helpful for confirmation • Fetal Lobulation ○ Multiple indentations in renal outline, between renal pyramids or calyces; preserved cortical thickness ○ Distinguished from scars of pyelonephritis, which are directly over calyces with thinned cortex • Dromedary Hump ○ Only occurs in left kidney: "Splenic hump" ○ Focal bulge in lateral border of midpole of left kidney with similar echogenicity as rest of kidney ○ Calyces extend laterally into hump, which contains normal vessels, unlike tumor • Hypertrophy Next to Scar ○ Hypertrophied normal renal tissue adjacent to an area of cortical loss ○ Similar echogenicity to normal parenchyma without vascular distortion • Focal Pyelonephritis/Abscess ○ Pyelonephritis: Cortical hypo-/hyperechoic lesion with decreased color Doppler flow, lacking external bulge ○ Abscess: Thick-walled cystic lesion, clinical correlation essential, may need aspiration Helpful Clues for Less Common Diagnoses • Crossed Fused Ectopia ○ Kidney-like morphology, absence of contralateral kidney • Hematoma ○ Echogenicity varies with age, avascular • Arteriovenous Malformation ○ Tubular, internal color flow • Focal Xanthogranulomatous Pyelonephritis ○ Hypoechoic lesion with calculi • Extramedullary Hematopoiesis ○ Single or multiple lesions in patients with hematolologic disease, may require biopsy for diagnosis Alternative Differential Approaches • Consider CECT, CEUS or CEMR if ultrasound is nondiagnostic • Clinical correlation is essential (Left) Longitudinal ultrasound of the right kidney shows a lobulated lesion in the mid kidney st between pyramids ſt. The lesion is continuous with renal cortex and slightly hyperechoic to renal cortex secondary to anisotropy. (Right) Longitudinal color Doppler ultrasound of the same lesion st shows no increase in color flow as might be seen in a solid renal tumor. Column of Bertin Column of Bertin 972
- Page 942 and 943: Cystic Pancreatic Lesion Helpful Cl
- Page 944 and 945: Cystic Pancreatic Lesion Mucinous C
- Page 946 and 947: Solid Pancreatic Lesion ○ Usually
- Page 948 and 949: Solid Pancreatic Lesion Serous Cyst
- Page 950 and 951: Pancreatic Duct Dilatation Chronic
- Page 952 and 953: PART III SECTION 4 Spleen Focal Spl
- Page 954 and 955: Focal Splenic Lesion - Typically mu
- Page 956 and 957: Focal Splenic Lesion Pyogenic Absce
- Page 958 and 959: Focal Splenic Lesion Splenic Infarc
- Page 960 and 961: PART III SECTION 5 Urinary Tract 9
- Page 962 and 963: Intraluminal Bladder Mass Bladder C
- Page 964 and 965: Abnormal Bladder Wall □ Uterine c
- Page 966 and 967: Abnormal Bladder Wall Invasion by P
- Page 968 and 969: PART III SECTION 6 Kidney Enlarged
- Page 970 and 971: Enlarged Kidney - Nonneoplastic cau
- Page 972 and 973: Enlarged Kidney Perinephric Fluid C
- Page 974 and 975: Small Kidney ○ Pseudotumors from
- Page 976 and 977: Small Kidney Postobstructive Atroph
- Page 978 and 979: Hypoechoic Kidney • Multiple Myel
- Page 980 and 981: Hypoechoic Kidney Acute Renal Arter
- Page 982 and 983: Hyperechoic Kidney ○ Echogenic co
- Page 984 and 985: Hyperechoic Kidney Chronic Glomerul
- Page 986 and 987: Cystic Renal Mass ○ Associated wi
- Page 988 and 989: Cystic Renal Mass Multicystic Dyspl
- Page 990 and 991: Solid Renal Mass • Horseshoe Kidn
- Page 994 and 995: Renal Pseudotumor Column of Bertin
- Page 996 and 997: Dilated Renal Pelvis • Intrarenal
- Page 998 and 999: Dilated Renal Pelvis Pyonephrosis P
- Page 1000 and 1001: PART III SECTION 7 Abdominal Wall/P
- Page 1002 and 1003: Diffuse Peritoneal Fluid Hemoperito
- Page 1004 and 1005: Solid Peritoneal Mass - Higher dens
- Page 1006 and 1007: Solid Peritoneal Mass Mimics Benign
- Page 1008 and 1009: Cystic Peritoneal Mass ○ Women of
- Page 1010 and 1011: Cystic Peritoneal Mass Pseudomyxoma
- Page 1012 and 1013: PART III SECTION 8 Prostate Enlarge
- Page 1014 and 1015: Enlarged Prostate Benign Prostatic
- Page 1016 and 1017: Focal Lesion in Prostate ○ Variab
- Page 1018 and 1019: Focal Lesion in Prostate Müllerian
- Page 1020 and 1021: PART III SECTION 9 Bowel Bowel Wall
- Page 1022 and 1023: Bowel Wall Thickening - Distal ileu
- Page 1024 and 1025: Bowel Wall Thickening Crohn Disease
- Page 1026 and 1027: Bowel Wall Thickening Clostridium D
- Page 1028 and 1029: PART III SECTION 10 Scrotum 1008
- Page 1030 and 1031: Diffuse Testicular Enlargement Test
- Page 1032 and 1033: Decreased Testicular Size Testicula
- Page 1034 and 1035: Testicular Calcifications Sertoli C
- Page 1036 and 1037: Focal Testicular Mass - Most common
- Page 1038 and 1039: Focal Testicular Mass Testicular Ly
- Page 1040 and 1041: Focal Extratesticular Mass - 3-50 m
Renal Pseudotumor<br />
Differential Diagnoses: Kidney<br />
DIFFERENTIAL DIAGNOSIS<br />
Common<br />
• Column of Bertin<br />
• Renal Junction Line, Junctional Parenchymal Defect<br />
• Fetal Lobulation<br />
• Dromedary Hump<br />
• Hypertrophy Next to Scar<br />
• Focal Pyelonephritis/Abscess<br />
Less Common<br />
• Crossed Fused Ectopia<br />
• Hematoma<br />
• Arteriovenous Malformation<br />
• Focal Xanthogranulomatous Pyelonephritis<br />
• Extramedullary Hematopoiesis<br />
• Splenorenal Fusion<br />
ESSENTIAL INFORMATION<br />
Key Differential Diagnosis Issues<br />
• Differentiate pseudotumors composed of normal variants<br />
from nonneoplastic lesions mimicking renal masses<br />
• Note typical locations of normal variant pseudotumors<br />
• Rare to have mass effect or distortion of normal<br />
architecture/vessels<br />
Helpful Clues for Common Diagnoses<br />
• Column of Bertin<br />
○ Isoechoic, continuous with renal cortex, normal renal<br />
outline<br />
○ No abnormal vascularity on color Doppler<br />
○ Junction of upper <strong>and</strong> middle 1/3 of kidney<br />
○ Changing sonographic window may clarify nature<br />
• Renal Junction Line, Junctional Parenchymal Defect<br />
○ Echogenic line at anterosuperior aspect of kidney<br />
without disruption of renal contour or cortical loss<br />
○ Junction of upper <strong>and</strong> middle 1/3 of kidney <strong>and</strong> right<br />
side most common location<br />
○ Junctional parenchymal defect: Triangular echogenic<br />
defect in renal cortex, upper to mid 1/3<br />
○ Cine clips are helpful for confirmation<br />
• Fetal Lobulation<br />
○ Multiple indentations in renal outline, between renal<br />
pyramids or calyces; preserved cortical thickness<br />
○ Distinguished from scars of pyelonephritis, which are<br />
directly over calyces with thinned cortex<br />
• Dromedary Hump<br />
○ Only occurs in left kidney: "Splenic hump"<br />
○ Focal bulge in lateral border of midpole of left kidney<br />
with similar echogenicity as rest of kidney<br />
○ Calyces extend laterally into hump, which contains<br />
normal vessels, unlike tumor<br />
• Hypertrophy Next to Scar<br />
○ Hypertrophied normal renal tissue adjacent to an area of<br />
cortical loss<br />
○ Similar echogenicity to normal parenchyma without<br />
vascular distortion<br />
• Focal Pyelonephritis/Abscess<br />
○ Pyelonephritis: Cortical hypo-/hyperechoic lesion with<br />
decreased color Doppler flow, lacking external bulge<br />
○ Abscess: Thick-walled cystic lesion, clinical correlation<br />
essential, may need aspiration<br />
Helpful Clues for Less Common Diagnoses<br />
• Crossed Fused Ectopia<br />
○ Kidney-like morphology, absence of contralateral kidney<br />
• Hematoma<br />
○ Echogenicity varies with age, avascular<br />
• Arteriovenous Malformation<br />
○ Tubular, internal color flow<br />
• Focal Xanthogranulomatous Pyelonephritis<br />
○ Hypoechoic lesion with calculi<br />
• Extramedullary Hematopoiesis<br />
○ Single or multiple lesions in patients with hematolologic<br />
disease, may require biopsy for diagnosis<br />
Alternative Differential Approaches<br />
• Consider CECT, CEUS or CEMR if ultrasound is<br />
nondiagnostic<br />
• Clinical correlation is essential<br />
(Left) Longitudinal ultrasound<br />
of the right kidney shows a<br />
lobulated lesion in the mid<br />
kidney st between pyramids<br />
ſt. The lesion is continuous<br />
with renal cortex <strong>and</strong> slightly<br />
hyperechoic to renal cortex<br />
secondary to anisotropy.<br />
(Right) Longitudinal color<br />
Doppler ultrasound of the<br />
same lesion st shows no<br />
increase in color flow as might<br />
be seen in a solid renal tumor.<br />
Column of Bertin<br />
Column of Bertin<br />
972
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