Which ultrasonography findings are characteristic of renal cell carcinoma (RCC)?

Updated: Dec 13, 2018
  • Author: Deborah A Baumgarten, MD, MPH; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

On sonograms, renal cell carcinoma can be isoechoic, hypoechoic, or hyperechoic relative to the remainder of the renal parenchyma. Smaller lesions with less necrosis are more likely to be hyperechoic and may be confused with AMLs. Isoechoic tumors are detected only by distortion of the renal contour, focal enlargement of a portion of the kidney, or distortion of the central sinus fat. [44, 45, 46, 47, 48, 49]

(For sonograms of RCC, see the images below.)

Case 21. Right renal cell carcinoma. Ultrasonogram Case 21. Right renal cell carcinoma. Ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultra Case 21. Right renal cell carcinoma. Doppler ultrasonogram.
Case 21. Right renal cell carcinoma. Doppler ultra Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained prior to the intravenous administration of ultrasonographic contrast agent.
Case 21. Right renal cell carcinoma. Doppler ultra Case 21. Right renal cell carcinoma. Doppler ultrasonogram obtained after the intravenous administration of ultrasonographic contrast agent.
Case 22. Left renal cell carcinoma. Ultrasonogram. Case 22. Left renal cell carcinoma. Ultrasonogram.
Case 22. Left renal cell carcinoma. Nonenhanced CT Case 22. Left renal cell carcinoma. Nonenhanced CT scan.
Case 22. Left renal cell carcinoma. Contrast-enhan Case 22. Left renal cell carcinoma. Contrast-enhanced CT scan.
Case 22. Left renal cell carcinoma. Anterior compo Case 22. Left renal cell carcinoma. Anterior component of circumaortic renal vein is normal.
Case 22. Left renal cell carcinoma. Posterior comp Case 22. Left renal cell carcinoma. Posterior component of circumaortic renal vein is normal.

For the workup in RCC, US is used primarily to differentiate solid masses from simple cysts and to visualize the internal architecture of lesions more effectively than can be accomplished by using CT or MRI.

Studies suggest a role for contrast-enhanced Doppler US (CEUS) in the workup of masses showing poor enhancement at arterial phase CT. [44, 45, 50] In one series of 26 pathologically proven malignant masses, CT failed to show arterial enhancement in 5. In all 5, blood flow was confirmed with CEUS.


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