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Unspecific cortical lesion on CT scan is confirmed cystic and benign with contrast-enhanced renal ultrasonography.. A CT scan is the first choice modality for workup of solid masses in the kidneys.
Approximately 40 to 60% of these lesions are ultimately found to be malignant, most commonly in the forms of cystic renal cell carcinoma and its multiloculated variant. [8] [9] [10] The remaining lesions are benign and include hemorrhagic cysts, chronic infected cysts, and multiloculated cystic nephromas.
The kidney is divided into parenchyma and renal sinus. The renal sinus is hyperechoic and is composed of calyces, the renal pelvis, fat and the major intrarenal vessels. In the normal kidney, the urinary collecting system in the renal sinus is not visible, but it creates a heteroechoic appearance with the interposed fat and vessels.
For small exophytic lesions that do not extensively involve the major vessels or urinary collecting system, a partial nephrectomy (also referred to as "nephron sparing surgery") can be performed. This may involve temporarily stopping blood flow to the kidney while the mass is removed as well as renal cooling with an ice slush.
Since kidney function may already be impaired (up to half the kidney may be lost before function loss is detectable), preserving as much kidney as possible is vital when removing any lesion. Large angiomyolipomas are treated by embolization, which reduces the risk of hemorrhage and can also shrink the lesion.
Gross appearance of a renal oncocytoma (left of image) and a slice of a normal kidney (right of image). Note the rounded contour, the mahogany colour and the central scar. In gross appearance, the tumors are tan or mahogany brown, well circumscribed and contain a central scar. They may achieve a large size (up to 12 cm in diameter).
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