Presentation
Painless hematuria
Patient Data
A huge exophytic cystic lesion arises from the upper portion of the right kidney, exerting mass effect on adjacent abdominal structures, displacing them to the left side and upon the IVC (causing right-sided varicocele). This lesion shows a thick wall, thick internal septation with calcification, and few enhancing nodules of convex border. There is outer bulging of the cyst in its inferior aspect, abutting the transverse colon without a clear fat cleavage line. This cystic lesion measures about 15.2 x 19 x 18.5 cm, surrounded by subtle fat plane stranding.
A small oval-shaped adjacent lymph node measures 1 x 2 cm.
Patent renal vein.
The right kidney is supplied by two arteries appearing opacified with contrast.
Bilateral few small renal cysts.
Case Discussion
Bosniak IV cystic masses carry a risk of over 91% for being malignant lesions.
Management usually includes partial or total nephrectomy.
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