PMC2902215_01
(a) Tc-99m DTPA renogram (PA). Tc-99m DTPA renogram (AP); (b) Tc-99m DTPA renogram (AP)
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Technetium-99m diethylene triamine penta acetic acid (Tc-99m DTPA) under a large field of view Gamma camera revealed a relative renal function of 45% in left kidney and 55% in the right kidney [Figure 1]. The overall scan impression was that of an enlarged left kidney with mild functional impairment.
CECT (a,b) revealed a large multiloculated cystic mass arising from left kidney, impinging upon the pelvis and causing hydronephrosis
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Contrast-enhanced CAT scan of abdomen (CECT) revealed large multiloculated cystic mass arising from left kidney, impinging on pelvis and causing hydronephrosis [Figure 2].
TC-99m MDP bone scan
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Tc-99m Methylene Diphosphonate (MDP) bone scan revealed abnormal tracer uptake in multiple ribs, femur, pelvis, foot bones, tibia and 9th, 10th and 11th dorsal vertebrae [Figure 3].
(a) Arteriovenous anomaly: Tangle of abnormal muscularized arteries and ecstatic veins without intervening capillaries (H and E, x400); (b) Masson's trichrome showing abnormal muscularized and fibrotic arterial walls (MTC, x400)
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Histopathological examination (HPE) revealed arterial malformation of kidney [Figure 4].
(a, b) Irregular, hyperosteotic changes of cortex, resembling melting wax dripping on the side of a candle. Dense sclerotic linear areas are seen, mainly in the cortex
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In view of the long history, good performance status and histopathological examination, skeletal survey was done, which revealed hyperostosis of long bones, and the bone of foot resembling wax dripping on one side [Figure 5].