Incidental heterogenous mass centered on the central right kidney.  The differential is between a centrally placed renal cell carcinoma or a renal pelvis transitional cell carcinoma. 

This study was performed for an alternative indication and hence only a single portal venous phase.  If the clinical indication pertained to the renal tract a multiphase study would have been performed making the diagnosis more straightforward.

Discussed at a clinico-radiological meeting as to whether it was a renal cell carcinoma or a pelvic transitional cell carcinoma.

Multi-phase imaging offered, in particular a excretory phase study to delineate of this mass is renal parenchymal derived or within the pelvis - in which case it would be clearly elucidated as a filling defect in the renal pelvis. Urologists decided to perform a retrograde study in theater - no collecting system abnormality (images not available). 

Final diagnosis was of a renal cell carcinoma.

The case highlights the value of:

• good referral practices
• importance of robust vetting and protocol selection
• value of clinico-radiological discussion
• holistic approach to imaging with multi-modality studies