Exposition of a renal cell carcinoma (RCC) with an associated pelvis mass on ultrasound

Jake Wheater, Michelle Hood, Radiology, Sheffield Teaching Hospitals NHS Trust

Common metastases include ovarian and pelvic tumours; however an incidental finding of a solitary tumour is the most likely presentation. Prognosis largely depends on the stage of the cancer upon discovery, with survival rates decreasing significantly if the cancer has metastasised (NHS, 2016), highlighting the importance of early diagnosis; which ultrasound (US) is an acknowledged part. This case study will focus on US in a patient with RCC and an associated pelvic mass. US arguably has the largest role to play in the diagnosis of this RCC. Its initial diagnostic value is huge, owing to it being the first imaging modality for most abdominal complaints. Furthermore, US is not solely limited to diagnosis through B-mode visualisation. In addition, recent developments such as CEUS, elastography and fusion imaging in conjunction with guided percutaneous biopsies make it difficult to perceive a more complete modality for RCC assessment. This work makes recommendations for future practice, deeming it necessary to improve the assessment of iliac venous velocities in lower limb doppler studies. It may also be beneficial to extend a negative Doppler scan further to assess the pelvis, as adnexal scanning was proved integral. However, US as a staging modality is not advocated, due to lack of sensitivity, specifically in IVC assessment in this case. Furthermore, huge diagnostic and management benefits would likely be granted to this patient if CEUS and fusion imaging were commonly used, alongside a ‘one stop’ scan and biopsy clinic for kidney lesions. This work has highlighted throughout how US use is fundamental to earlier and accurate diagnosis, treatment and management

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