PMC2718205_01
A 60-year-old man with gross hematuria first noted ten days earlier.. A. Delayed enhanced CT image shows a well-circumscribed, right renal mass (arrow) involving the lower pole calyx. Areas of low attenuation (arrowheads) are present in adjacent renal parenchyma.. B. Retrograde pyelography revealed a dilated lower pole calyx with irregular filling defect (arrow).. C. Gray-scale US demonstrated a round, homogeneously hypoechoic lesion, 1.6 cm in diameter, at the lower pole of the right kidney (not shown). Unenhanced power Doppler US revealed no definite tumoral vascularity.. D. Harmonic power Doppler US image obtained 150 seconds after the injection of contrast agent shows dot-like, linear power Doppler US signals within the mass (arrow). These were not depicted by unenhanced power Doppler US (C).. E. Conventional power Doppler US image obtained 7 minutes after injection also shows dot-like, linear power Doppler US signals. Compared with harmonic power Doppler US, severe blooming artifacts around and within the kidney are noted (curved arrows).. F. Photomicrograph of a histologic specimen shows marked proliferation of myofibroblasts and capillaries with infiltration of lymphocytes, plasma cells and macrophages. Mitotic activity was low, and cellular atypism was minimal.
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F1
Abdominal CT performed at another hospital revealed the presence of a well-defined right renal mass involving the lower pole (Fig. 1A). RGP revealed a dilated lower pole calyx with irregular filling defect (Fig. 1B). On power Doppler US, multiple vascularities meandering around the mass were identified, but none were seen within it (Fig. 1C). The harmonic power Doppler US images obtained 150 seconds after injection showed dot-like and linear power Doppler US signals within the mass (Fig. 1D), and the conventional power Doppler US images obtained 7 minutes after injection also showed these same signals (Fig. 1E). Mitotic activity was low, and cellular atypism was minimal (Fig. 1F).