Renal scars masquerading as complex masses in a patient with vesicoureteral reflux nephropathy.

Vesicoureteral reflux can lead to chronic pyelonephritis, renal scarring, and renal failure. We present a case of renal scarring masquerading as bilateral, complex renal masses. A 35-year old woman who was diagnosed with vesicoureteral reflux as a child presented for evaluation of recently developed hypertension and an abnormal renal ultrasound. Her serum creatinine level was 2.5 mg/dL and she had subnephrotic-range proteinuria. A renal sonogram showed small, echogenic kidneys and bilateral complex renal masses of 3.8 (right) and 4.4 (left) cm in greatest dimensions. CT scan of the kidneys revealed slightly contrast-enhancing masses with irregular walls. Renal angiogram showed decreased blood supply to the areas coinciding with the masses consistent with renal scarring. There was no increased vascularity. This case demonstrates that renal scarring may masquerade as renal masses. A step-wise, comprehensive approach is necessary to rule out potentially malignant lesions in these patients.

Implementation of the STOP protocol for Stroke Prevention in Sickle Cell Anemia by using duplex power Doppler imaging.

PURPOSE: To compare the results of the nonduplex ultrasonography (US) Stroke Prevention Trial in Sickle Cell Anemia (STOP) with those of transcranial duplex power Doppler US by using the STOP protocol and to correlate abnormal transcranial Doppler findings with magnetic resonance (MR) imaging and MR angiographic findings. MATERIALS AND METHODS: One hundred twenty-five asymptomatic patients aged 2-16 years with sickle cell anemia or sickle cell-beta thalassemia were examined by using transcranial duplex power Doppler US with a 2.5-MHz transducer and classified according to STOP criteria. The results were compared with those obtained in the nonduplex STOP study. Eight of 10 patients with abnormal results, as well as one who had normal results and a subsequent stroke, were examined with MR imaging and MR angiography. RESULTS: Ten (8.0%) patients were judged to have abnormal findings by using the duplex Doppler US and STOP criteria compared with 9.4% of patients in the nonduplex US STOP study. Of the eight patients with abnormal transcranial Doppler US results who underwent MR imaging and MR angiography, six had abnormal MR imaging findings and all eight had abnormal MR angiographic findings. CONCLUSION: The STOP protocol can be reproduced by using duplex power Doppler US. Abnormal results with the STOP criteria strongly suggest vascular abnormality.

Prospective pretransplant ultrasound screening in 206 patients for acquired renal cysts and renal cell carcinoma.

BACKGROUND: Numerous studies have reported an increased prevalence of renal cell carcinoma in association with acquired cystic kidney disease (ACKD). In 1995, the clinical practice guidelines of the American Society of Transplant Physicians for evaluation of renal transplant candidates recommend not screening for ACKD and renal cell carcinoma, on the basis of the low frequency of cancer and reported regression of ACKD after transplantation. The objective of this study was to prospectively evaluate the prevalence of ACKD and renal cancer during renal transplant evaluation. METHODS: A total of 206 consecutive adult patients evaluated for renal transplantation underwent a routine renal ultrasound. Patients with a suspicious ultrasound underwent a contrasted computed tomographic scan of the kidneys followed by excision of kidneys with solid, enhancing (>10 Hounsfield units) lesions. RESULTS: Sixty-three (30.6%) of 206 patients had ACKD, with a greater proportion being male, African-American, and dialysis-dependent for a longer duration. Eight patients (3.8%) had histologically proven localized cancer (six unilateral, two bilateral), seven in association with ACKD and one in association with autosomal dominant polycystic kidney disease. With a mean follow-up of 14 months (range, 3-33 mo), there has been no recurrence. The positive predictive value of a solid lesion on ultrasound was 100% (8 of 8 patients). CONCLUSION: With the high prevalence (3.4%) of renal cell carcinoma in association with ACKD and the concern that immunosuppression accelerates the growth of preexisting cancers, we continue to recommend ultrasound screening of the native kidneys before renal transplantation.

Mesenteric cystic lymphangioma: radiologic appearance mimicking cystic teratoma.

Lymphangiomas are benign multiloculated cystic tumors. We present radiologic and pathologic findings of a mesenteric lymphangioma containing calcification and mimicking a mesenteric teratoma. This may broaden the differential diagnosis of a cystic mesenteric mass containing calcification.

Gravid uterine dehiscence: MR findings.

Gravid uterine rupture can be a difficult diagnosis, both clinically and radiologically. Ultrasound has been successful in detection of some indirect signs of uterine rupture but thus far has shown little success in demonstrating the myometrial defect. We present the MR findings in a case of gravid uterine dehiscence in which the actual uterine wall defect was well demonstrated. Gross pathologic correlation is provided.

Pseudothrombosis of the right ovarian vein. Pitfall of abdominal spiral CT.

We present the computed tomography (CT) findings of pseudothrombosis of the right ovarian vein. In two young multiparous women, pseudothrombosis was detected on early-phase spiral CT scans by the presence of retrograde flow of contrast medium down the left ovarian veins. Asymmetry of density seen in the ovarian veins in the early phase of spiral CT scanning related to reflux in the left ovarian vein should not be mistaken for right ovarian vein thrombosis.

Müllerian duct cyst masquerading as chronic prostatitis: diagnosis with magnetic resonance imaging using a phased array surface coil.

Prostatitis is a common clinical syndrome that on rare occasions may result from mass lesions in the pelvis. This report concerns a man with debilitating prostatitis that was caused by a müllerian duct cyst. The diagnosis was facilitated by examination with magnetic resonance imaging using a pelvic phased array surface coil and a small field of view.

Fibrolamellar hepatocellular carcinoma: MR appearance mimicking focal nodular hyperplasia.

We report the MR findings of a case of fibrolamellar hepatocellular carcinoma that fulfilled MR criteria proposed as diagnostic of focal nodular hyperplasia. Because confusion of fibrolamellar carcinoma with focal nodular hyperplasia could result in a missed opportunity for cure, pathologic assessment remains necessary in cases demonstrating these MR findings that do not show radiotracer uptake on 99mTc-sulfur colloid scintigraphy.

Cavernous hemangioma of the adrenal gland: MR findings.

Adrenal hemangioma is considered a rare tumor and is pathologically similar to hemangiomas found elsewhere in the body. Magnetic resonance imaging (MRI) findings thought to be highly suggestive of this neoplasm are presented. Correlation with pathologic findings in this case, as well as imaging and pathologic findings in other reported cases, is provided.

Diffuse lung calcifications following fat emboli and adult respiratory distress syndromes: CT findings.

We present a case of diffuse lung calcifications that developed following fat emboli and adult respiratory distress syndrome. Computed tomography (CT) showed the majority of the calcifications to be within branches of the pulmonary arteries. High-resolution CT findings helped to characterize associated lung parenchymal changes.

Emergence of mature teratoma following treatment of sacrococcygeal endodermal sinus tumor: CT and MR imaging with pathological correlation.

We report a case of pseudoretroconversion in which, clinically and pathologically, it appeared that an endodermal sinus tumor retroconverted to mature teratoma. An 8-month-old white female infant with a sacrococcygeal tumor, diagnosed by biopsy as endodermal sinus tumor (yolk sac tumor), was treated with chemotherapy. The residual tumor after treatment was mature teratoma confirmed by imaging and by pathological examination. We present the computerized tomography (CT) and magnetic resonance imaging (MRI) findings with pathological correlation.

Imaging of childhood non-Hodgkin lymphoma: assessment by histologic subtype.

The types of childhood non-Hodgkin lymphoma (NHL) differ considerably from Hodgkin lymphoma and NHL seen in adults, both pathologically and clinically. Essential to understanding these differences is a knowledge of the three major histologic subtypes (undifferentiated, lymphoblastic, and large cell) that account for the vast majority of cases of pediatric NHL. Each of these subtypes has typical imaging and clinical features. The most common subtype, undifferentiated NHL, usually shows intraabdominal disease. Lymphoblastic tumors most frequently manifest as a mediastinal mass, perhaps with respiratory or circulatory compromise. Large cell tumors show heterogeneous clinical and imaging features but tend to spare the anterior mediastinum. Knowledge of the appropriate imaging modality to be used in evaluation of these tumors is also important. Computed tomography (CT) is the primary imaging modality for staging childhood NHL. Magnetic resonance imaging is best for examination of the central nervous system and bone involvement. Ultrasonography may be useful as a complementary study to abdominal CT; gallium scintigraphy also plays an adjunctive role to CT. Familiarity with typical and atypical patterns of tumoral behaviors and optimal imaging methods aid in the diagnosis and appropriate follow-up of these tumors.

Intrarenal aneurysm associated with "Ask-Upmark kidney": imaging pitfalls and limitations.

The imaging of a case of intrarenal aneurysm with associated "Ask-Upmark kidney" is presented. Pitfalls and limitations encountered with imaging in this case are discussed. Magnetic resonance imaging (MRI) proved to be the best imaging modality for visualization and characterization of the mass lesions present.

Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT.

Disease processes in the peritoneum, omentum, and mesentery occasionally are not recognized at radiologic examination. The authors have used computed tomography (CT) to categorize the radiologic appearances of the more common abnormalities into three basic patterns: (a) solid but relatively well-defined masses, (b) cystic-appearing masses, and (c) ill-defined or infiltrative processes. The most common solid masses to affect these anatomic regions are secondary neoplasms, which are associated with enhancement of the peritoneum on contrast material-enhanced CT scans and, typically, ascites. The various cystic-appearing masses (including cystic lymphangioma, cystic mesothelioma, teratoma, and loculated ascites) and infiltrating masses (such as peritoneal mesothelioma, retractile mesenteritis, desmoid, and carcinoid) must be differentiated on the basis of clinical findings and additional imaging findings (eg, CT depiction of fat and calcium in teratomas and the radiating appearance of carcinoids). Although the CT appearances of some of the abnormalities overlap, classifying them by pattern is helpful in narrowing the range of the differential diagnosis.

Thrombosis of the IVC and azygous continuation of IVC by bronchogenic cancer: CT and MRI appearance.

The authors describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings in a patient with thrombosis of the inferior vena cava (IVC) and azygous continuation of the IVC caused by bronchogenic carcinoma. CT has been touted as the modality of choice for mediastinal evaluation. MRI is presently considered to be the initial modality of choice for mediastinal vessel evaluation. MRI is noninvasive, there is no radiation dose to the patient, multiplanar imaging can be done, and there is no need for iodinated contrast material. The satisfactory evaluation of an individual patient may require the use of MRI and CT in a complementary fashion.

Cystic masses of the pancreas.

Although the pseudocyst is the most common cystic mass of the pancreas found at imaging studies, radiologists should be aware of the multiple disease processes that can manifest in a similar manner. This article reviews these other entities by category of the origin of the mass, including congenital, inflammatory, and neoplastic. Computed tomography, ultrasound, and magnetic resonance imaging studies are presented, and, although the considerable overlap of imaging features makes it generally impossible to render a specific diagnosis, combining the findings from these modalities is helpful in formulating a differential diagnosis. Because a cystic mass of the pancreas is not always a pseudocyst, percutaneous drainage should be followed by cytologic analysis of the aspirate. A biopsy of the wall of the cystic mass may also be necessary.