CT FINDINGS IN A 75 YEAR OLD FEMALE PATIENT WITH HEMATURIA.

Background: Renal cancer associated with horseshoe kidney is uncommon. It seems that the incidence of renal cancer in horseshoe kidney is no higher than in general population. So far, there have been reported 196 cases of renal cancer occurred within a horseshoe kidney. Surgical treatment is conditioned by tumor location and imaging studies are essential. Material and methods: A contrast-enhanced CT scan was performed on a 75 year old female patient referred to our Department of Radiology and Imaging. The study included the unenhanced sequence followed by intravenous administration of 100 ml of Visipaque (3 ml/sec flow rate). Contrast-enhanced sequences were performed with bolus tracking technique (100 HU density of superior abdominal aorta as treshold). Arterial phase was followed by venous phase with a delay of 35 seconds. Multiplanar reconstructions (MPR) and maximum intensity projection (MIP) were used for the assessment of patient pathology. Results: Examination of the images revealed the presence of a horseshoe kidney and a solid mass (52/56 mm) which infiltrated the isthmus and the left inferior renal pole. Contrast-enhanced sequences showed the hypervascular character of the mass with central low attenuated areas of necrosis. Many precaval and preaortic enlarged lymph nodes were observed. Another enhancing solid mass of 31 mm has been observed in the right upper lobe of the lung and a mass of 33 mm in the right psoas muscle with lysis in the adjacent vertebral body. The aspect was highly suggestive for renal cell carcinoma with retroperitoneal metastatic adenopathies and two distant metastases. Conclusions: CT scan is a very useful imaging method for renal tumor diagnosis and staging. It is also necessary before planning the surgery. [ABSTRACT FROM AUTHOR]