Which ultrasonographic findings are characteristic of Wilms tumor?

Updated: Mar 04, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Ultrasonographic findings may be summarized as follows:

  • The mass is solid at presentation and usually >10 cm.

  • Echogenicity is variable; the lesions are generally echogenic, but cysts within the tumor contribute to the complexity; these cysts may due to tumor necrosis, deposits of mucin, or simply trapped calyces.

  • Calcification is uncommon; when present, it is usually irregular and amorphous.

  • Intense echogenic foci in the tumor may be related to fat deposition.

  • The IVC should be imaged to the level of the right atrium to assess for extension of the tumor; IVC-related tumor extension may be seen on real-time ultrasonography and, if necessary, confirmed with Duplex or color Doppler imaging; tumors on the right side may compress the IVC and make it difficult to visualize, though the IVC may be patent.

  • The contralateral kidney should always be examined because 6% of tumors are bilateral at the time of presentation and because their detection alters primary therapy.

  • Anomalies that could alter surgery (eg, contralateral renal agenesis, horseshoe kidney, pelviureteric [PUJ] obstruction) must be excluded.

  • An imaging review indicates that the addition of other imaging studies to plain abdominal radiography and ultrasonography does not alter patients' outcomes.


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