83 Wilms’ Tumor

CASE 83


Clinical Presentation


A 2-year-old girl presents with a palpable right-sided abdominal mass.


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Figure 83A


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Figure 83B


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Figure 83C


Radiologic Findings


Axial CT images after intravenous contrast enhancement show a large heterogeneous mass arising from the right kidney (Fig. 83A). More superior sections through the liver (Fig. 83B) and heart (Fig. 83C) show distended but non-opacified inferior vena cava (IVC), a right pleural effusion, and a filling defect in the right atrium due to tumor thrombus extension along the IVC into the right side of the heart. Note the enlarged azygos vein adjacent to the aorta on Fig. 83C.


Diagnosis


Wilms’ tumor with tumor thrombus in the IVC


Differential Diagnosis



  • Hydronephrosis (Renal parenchymal distortion without excess intrarenal fluid and solid components to the mass exclude this from the differential diagnosis.)
  • Mesoblastic nephroma (rare in a child >1 year of age)
  • Other malignant renal tumors of childhood (such as a clear cell sarcoma or rhabdoid tumor) have similar appearances to a Wilms’ tumor but are much less common.
  • Renal cell carcinoma (occurs occasionally in children but uncommonly before 5 years of age)
  • Neuroblastoma (typically is suprarenal in origin and displays encasement of the retroperitoneal vessels rather than simple displacement)

Discussion


Background

Dec 21, 2015 | Posted by in PEDIATRIC IMAGING | Comments Off on 83 Wilms’ Tumor

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