KEY FACTS
Imaging
- •
Variable appearance: Solid, cystic, or complex
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Solid: Homogeneous or heterogeneous, hypervascular soft tissue components and areas of necrosis, calcifications
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Cystic variant: Unilocular or multilocular, fluid-debris levels (hemorrhage and necrosis), thick and irregular wall or septations, nodules
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Use Doppler for detection of internal vascularity
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RCC may be initially detected by US, but CECT and MR are primary tools for characterization and staging
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US may be useful in characterizing complex cystic lesions, indeterminate or equivocal on CECT or MR
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Contrast-enhanced US: Option for detection of perfusion analogous to enhancement on CT/MR
Top Differential Diagnoses
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Renal angiomyolipoma
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Transitional cell carcinoma (urothelial carcinoma)
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Renal oncocytoma
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Renal metastases and lymphoma
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Column of Bertin
Pathology
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Most common primary renal malignancy; most sporadic but can be hereditary (~ 4%)
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Risk factors: Smoking, obesity, long-term dialysis
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Variants: Clear cell, papillary, medullary RCC
Clinical Issues
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50-70 years of age
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M:F = 2:1; slightly higher in African Americans
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Gross hematuria (60%), flank pain (40%), palpable flank mass (30-40%); classic triad (< 10%)
- •
Fever, anorexia, weight loss, malaise, nausea, vomiting
- •
Most tumors now detected incidentally and are smaller
Scanning Tips
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Look for unequivocal blood flow in renal lesions, particularly in components of complex cystic lesions
. The renal vein 
is expanded with tumor thrombus, which extends into the inferior vena cava 
. A 2nd tumor nodule is seen 
.
. Note posterior acoustic enhancement 
; however, there was internal flow on color Doppler.
with infiltration and distortion of the renal sinus fat 
.
with peripheral 
and internal color flow 
.
that was a clear cell renal carcinoma.
in the partially exophytic hypoechoic mass 
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