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Renal Cell Carcinoma with lytic metastasis

Kehrer JDK - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Renal Cell Carcinoma with lytic metastasis

History: 70 y.o. hispanic male presents to ED with LUQ pain, fever, chills and diaphoresis s/p return from vacation to Mexico. Hx of documented lytic lesion left 10th rib and right 3rd rib on CT scan 1 yr prior. Notes weight loss x 1 year. Denies night sweats. Denies nausea or vomiting. No hematemesis or hematochezia/melena.

Findings: • PA and Lateral Chest Radiograph 1) Lytic bone lesions of the right posterior 3rd rib and left lateral 10th rib with associated soft tissue masses likely to represent metastatic disease. • Bone Scan: 1) Areas of photopenia with subtle regions of increased activity at left antero-lateral 10th rib and right posterior 3rd rib. Cannot exclude metastatic disease. 2)Poorly visualized right renal upper pole - unable to exclude pathologic abnormality. • CT Thorax/Abdomen with IV and PO Contrast: 1) Heterogeneous mass involving the superior pole of the right kidney consistent with area of photopenia on bone scan concerning for RCC. Accompanying right adrenal mass and expansile destructive lytic lesions left 10th rib and right 3rd rib concerning for metastasis. Multiple low attenuating cystic structures noted throughout the bilateral kidneys consistent with renal cysts.

Ddx: Renal Cell Carcinoma Angiomyolipoma Collecting Duct Carcinoma Hemorrhagic Cyst Infected Cyst Lymphoma Mets Oncocytoma Abscess Transitional Cell Carcinoma Differential Dx Cold Lesion on Bone Scintigraphy: Metastasis- Renal, thyroid, breast, lung Myeloma Infarct (early) Radiation Tx Bone Cyst Prostheses or attenuation artifacts Children- consider infection and neuroblastoma

Dxhow: CT and biopsy left 10th rib lesion

Exam: Vitals: Afebrile, HR 82, RR 15, BP 142/89, o2 Sat 97% RA PE: Gen: Anxious-appearing male in mild discomfort HEENT: EOMI, no pharyngeal erythema Cardiac: RRR, no murmurs, rubs or gallops, Normal S1/S2 Lungs: CTA bilaterally Abd: Mild diffuse tenderness to palpation, no rebound tenderness, BS x 4 Ext: TTP with palpable swelling lateral left 10th rib Labs: WBC 14.5 (no left shift) BUN 35, Cr 1.9, (+) Microscopic Hematuria Ca 8.2

No MeSH data available.


Area of photopenia noted in the left tenth rib laterally with subtle areas of increased radiotracer attenuation surrounding photopenic region.   Similar appearance to posterolateral region of third rib. Poor definition of the upper portion of the right kidney.
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MPX1008_synpic48841: Area of photopenia noted in the left tenth rib laterally with subtle areas of increased radiotracer attenuation surrounding photopenic region. Similar appearance to posterolateral region of third rib. Poor definition of the upper portion of the right kidney.


Renal Cell Carcinoma with lytic metastasis

Kehrer JDK - MedPix (2009)

Area of photopenia noted in the left tenth rib laterally with subtle areas of increased radiotracer attenuation surrounding photopenic region.   Similar appearance to posterolateral region of third rib. Poor definition of the upper portion of the right kidney.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1008&req=5

MPX1008_synpic48841: Area of photopenia noted in the left tenth rib laterally with subtle areas of increased radiotracer attenuation surrounding photopenic region. Similar appearance to posterolateral region of third rib. Poor definition of the upper portion of the right kidney.

View Article: MedPix Image - MedPix Case

Affiliation: Naval Medical Center San Diego

ABSTRACT

Diagnosis: Renal Cell Carcinoma with lytic metastasis

History: 70 y.o. hispanic male presents to ED with LUQ pain, fever, chills and diaphoresis s/p return from vacation to Mexico. Hx of documented lytic lesion left 10th rib and right 3rd rib on CT scan 1 yr prior. Notes weight loss x 1 year. Denies night sweats. Denies nausea or vomiting. No hematemesis or hematochezia/melena.

Findings: • PA and Lateral Chest Radiograph 1) Lytic bone lesions of the right posterior 3rd rib and left lateral 10th rib with associated soft tissue masses likely to represent metastatic disease. • Bone Scan: 1) Areas of photopenia with subtle regions of increased activity at left antero-lateral 10th rib and right posterior 3rd rib. Cannot exclude metastatic disease. 2)Poorly visualized right renal upper pole - unable to exclude pathologic abnormality. • CT Thorax/Abdomen with IV and PO Contrast: 1) Heterogeneous mass involving the superior pole of the right kidney consistent with area of photopenia on bone scan concerning for RCC. Accompanying right adrenal mass and expansile destructive lytic lesions left 10th rib and right 3rd rib concerning for metastasis. Multiple low attenuating cystic structures noted throughout the bilateral kidneys consistent with renal cysts.

Ddx: Renal Cell Carcinoma Angiomyolipoma Collecting Duct Carcinoma Hemorrhagic Cyst Infected Cyst Lymphoma Mets Oncocytoma Abscess Transitional Cell Carcinoma Differential Dx Cold Lesion on Bone Scintigraphy: Metastasis- Renal, thyroid, breast, lung Myeloma Infarct (early) Radiation Tx Bone Cyst Prostheses or attenuation artifacts Children- consider infection and neuroblastoma

Dxhow: CT and biopsy left 10th rib lesion

Exam: Vitals: Afebrile, HR 82, RR 15, BP 142/89, o2 Sat 97% RA PE: Gen: Anxious-appearing male in mild discomfort HEENT: EOMI, no pharyngeal erythema Cardiac: RRR, no murmurs, rubs or gallops, Normal S1/S2 Lungs: CTA bilaterally Abd: Mild diffuse tenderness to palpation, no rebound tenderness, BS x 4 Ext: TTP with palpable swelling lateral left 10th rib Labs: WBC 14.5 (no left shift) BUN 35, Cr 1.9, (+) Microscopic Hematuria Ca 8.2

No MeSH data available.