The ultrasound images of RCC is a (usually) large, heterogeneous mass which enlarges and deforms the shape of the kidney (Fig. below). The mass may contain areas of cystic degeneration and/or calcification. It has a predilection to spread into the ipsilateral renal vein and IVC (see also Chapter 8). olour Doppler usually reveals a disorganized and increased blood flow pattern within the mass with high velocities from the arterioverous shunts within the carcinoma. Smaller RCCs can be hyperechoic and may be confused with benign angiomyolipoma. The latter has well-defined borders whilst an RCC is illdefined: differentiation may not be possible on all occasions and biopsy or interval scan may be required. A chest X-ray and/or CT will demonstrate if metastases are present in the lungs. Liver, adrenal and lymph node metastases can be demonstrated on ultrasound but CT is used for staging purposes as ultrasound generally has a lower sensitivity for distant disease detection.
Ultrasound images The RK is almost completely replaced by a large renal carcinoma (T). The main renal vein contains tumour thrombus which has spread into the IVC. The main renal artery is seen alongside.
ultrasound images Colour Doppler of the tumour reveals vigorous, multidirectional blood flow within it.
ultrasound images Recurrence of carcinoma (between calipers) in the right renal bed of a patient following right nephrectomy for renal carcinoma
ultrasound images CT demonstrating a large left renal carcinoma.
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