What is the role of invasive imaging in the workup of Wilms tumor?

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Angiography is now uncommonly performed, but it may be useful in the preoperative assessment of tumors in patients with a solitary kidney or bilateral Wilms tumors. Likewise, inferior venacavography is now seldom performed, as magnetic resonance angiography (MRA) and Doppler imaging studies may provide the same information noninvasively.

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Media Gallery

This 6-year-old male child with hematuria was referred for a renal ultrasound scan. The scan shows a 6 x 8 cm solid mass at the lower pole of the right kidney displacing part of the collecting system in a cephalad direction. The mass is of uniform echogenicity with a vague small central hypoechoic area suggestive of tumor necrosis.
Unenhanced axial CT scans shows a 6 x 8 cm mass low attenuation mass arising from the lower pole of the right kidney and extending into the anterior renal cortex. Also note subtle unrelated medullary left renal nephrocalcinosis.
Enhanced axial CT scan shows a large solid tumor displacing a rim of functioning cortical tissue posteriorly. Note also a second small low attenuation mass in the functioning cortex.
An IVU shows a nonfunctioning left kidney with a suggestion of ill-defined mass in the left loin due to a biopsy-proven Wilms tumor. Note the functioning right duplex renal collecting system. The chest radiograph in the same child shows a lung metastatic deposit (arrow). Images courtesy Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Axial US image shows a solid 4.5-cm solid mass anterior cortex, lower pole of the left kidney. Image courtesy of Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Sagittal US scan of the left kidney (same patient as in the previous image). Image courtesy of Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Axial and coronal reconstruction contrast-enhanced CT scan shows a fairly well defined left renal mass with a small central hypodense area due to central necrosis. Image courtesy Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Color Doppler US scan of the right kidney in a sagittal plane shows a 13-cm upper-pole, mainly solid tumor with a heterogeneous echo pattern displacing the functioning component of the kidney inferiorly.
Color Doppler US scan of the right kidney in an axial plane shows a 13-cm upper-pole, mainly solid tumor with a heterogeneous echo pattern displacing the vessels and crossing the midline (same patient as in previous image). Images courtesy Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Unenhanced axial CT scans in the same patient as in the previous image shows a large, solid mass with a heterogeneous mass in the right renal fossa crossing the midline and displacing the liver anteriorly. Image courtesy of Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com
Contrast-enhanced axial CT scan in the same patient as in the previous images shows a large, solid mass with a heterogeneous mass with areas suggestive of necrosis. Note the normal functioning component of the right kidney. Image courtesy of Dr. Pedro Daltro and Dr. Edson Marchiori, Port Allegre, Brazil. edmarchiori@gmail.com

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Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Saeed Saleh Emam Mohammed, MD, MB, ChB Consulting Staff, Department of Medical Imaging, King Fahad National Guard Hospital, Saudi Arabia

Saeed Saleh Emam Mohammed, MD, MB, ChB is a member of the following medical societies: Royal College of Surgeons in Ireland

Disclosure: Nothing to disclose.

Klaus L Irion, MD, PhD Consulting Staff, The Cardiothoracic Centre Liverpool NHS Trust, The Royal Liverpool University Hospital, UK

Klaus L Irion, MD, PhD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Acknowledgements

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Fredric A Hoffer, MD, FSIR Professor of Radiology, University of Washington School of Medicine; Member, Quality Assurance Review Center

Fredric A Hoffer, MD, FSIR is a member of the following medical societies: Children's Oncology Group, Radiological Society of North America, Society for Pediatric Radiology, and Society of Interventional Radiology

Disclosure: Nothing to disclose.

Kieran McHugh, MBBCh Honorary Lecturer, The Institute of Child Health; Consultant Pediatric Radiologist, Department of Radiology, Great Ormond Street Hospital for Children, London, UK

Kieran McHugh, MBBCh is a member of the following medical societies: American Roentgen Ray Society and Royal College of Radiologists

Disclosure: Nothing to disclose.

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