Renal cell carcinoma

On the plain film there is an area of curvilinear calcification in the left upper quadrant. From the CT scan it is clear that there is a large partly calcified renal mass of irregular outline. The appearances are of a calcified renal cell carcinoma. Staging requires an assessment of the local extent of tumour, local invasion to surrounding structures and assessment of the renal vein and IVC: tumour/thrombus extending into the renal vein and inferior vena cava are frequent features. Metastases occur to lung (pulmonary nodules), bone (lytic lesions) and regional lymph nodes.

Polycythaemia can result due to erythropoietin production by tumour. Hypercalcaemia is a recognised finding due to a PTH-like hormone (Table 2.3).

Table 2.3 Causes of renal calcification

Renal calculi

■ Irregular calcification

• Renal artery calcification

Nephrocalcinosis (renal parenchymal calcification)

• Medullary sponge kidney

• Renal tubular acidosis

• Hypercalcaemia

• Transplant failure

• Acute cortical necrosis

26-year-old female. Poorly controlled hypertension.

■ What is the radiological treatment?

■ What pharmacological agents should be avoided?

Fig. 2.36 Quiz case.

26-year-old female. Poorly controlled hypertension.

■ What is the radiological treatment?

■ What pharmacological agents should be avoided?

Fig. 2.36 Quiz case.

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