Morton A. Bosniak

Angiomyolipoma (hamartoma) of the kidney: A preoperative diagnosis is possible in virtually every case

The preoperative diagnosis of renal angiomyolipoma should be made in virtually every case because of characteristic clinical and radiologic findings. The clinical, sonographic, computed tomographic, and angiographic findings in 28 patients with this lesion are reviewed. The sonographic findings of increased echogenicity in a renal mass can be helpful in suggesting the diagnosis of renal angiomyolipoma, and the detection of fat in the renal tumor by CT is diagnostic. It is important to make a preoperative diagnosis of this lesion so that the correct treatment approach will be instituted.

Pitfalls in Renal Mass Evaluation and How to Avoid Them

Characterization of renal masses with computed tomography (CT) and magnetic resonance (MR) imaging is usually clear-cut and accurate. However, potential pitfalls exist in diagnosis of renal masses, and it is necessary to understand these pitfalls to avoid misdiagnosis and possibly unnecessary surgery. Although some of the pitfalls are related to technical factors of the CT and MR imaging equipment, others are related to errors in image interpretation. To maximize detection and characterization of renal masses, the study should include images obtained before and after administration of intravenous contrast material, including images obtained during the nephrographic phase of enhancement. One should be aware of the potential unreliability of absolute Hounsfield unit measurements and of the existence of possible CT pseudoenhancement. When CT results are indeterminate, MR imaging may be helpful in demonstrating enhancement in renal masses. Before diagnosing a renal mass as a malignant neoplasm or suggesting surgery for a renal mass, one should consider alternative benign diagnoses; when appropriate, previous images or a supporting history should be obtained.

Angiographie Patterns in Renal Oncocytomas1

Renal oncocytomas are benign tumors arising from proximal tubular epithelial cells. They appear radiographically as solid masses which are vascular on angiography. Angiograms of 13 cases of renal oncocytomas were reviewed, as well as those of 155 renal-cell carcinomas. The classic angiographic findings for the oncocytoma include a spoke-wheel pattern, a homogeneous nephrogram, and a sharp, smooth rim. The finding of a homogenous blush and/or a spoke-wheel pattern greatly increases the possibility of an oncocytoma, though a renal-cell carcinoma may have any or all of the classical findings described for an oncocytoma.

Metastatic disease to the pancreas: evaluation by computed tomography.

Seven patients with one or more pancreatic masses due to metastases to the pancreatic parenchyma were studied by CT. Two patterns were observed. Three patients had multiple nodules studding the pancreatic surface. Four patients had a solitary focal mass indistinguishable from a primary pancreatic neoplasm. In patients with a solitary focal lesion surgical biopsy may be necessary to differentiate between metastasis and primary pancreatic carcinoma.

The Bosniak renal cyst classification: 25 years later.

In the past 25 years, there have been continuous advances in the diagnosis of disease throughout the body owing to the introduction of new technology and the experience gained with its use. However, the imaging and evaluation of complicated cystic lesions of the kidneys frequently remains a difficult problem. The classification of renal cystic lesions suggested 25 years ago, now referred to as the Bosniak renal cyst classification, remains pertinent to the diagnosis and management of these difficult-to-diagnose complicated cystic masses.

Renal imaging for diagnosis and staging of renal cell carcinoma

The development and expansion of CT and MRI technology have enhanced the detection and characterization of renal lesions. Although these advancements should lead to earlier diagnosis of renal cell carcinoma with subsequent improved cure rates, the increased imaging has also uncovered many cases that are problematic not only in diagnosis but in management as well. The performance of high-quality examinations combined with growing experience should improve the ability to diagnose and manage these cases successfully. Continued advances in CT and MR technology combined with the current trend toward minimally invasive surgery will continue to expand the role of preoperative imaging and, it is hoped, improve the cure rate of renal cancer.

Diffuse xanthogranulomatous pyelonephritis: Analysis by computed tomography and sonography

The sonographic and computed tomographic findings in 3 cases of diffuse xanthogranulomatous pyelonephritis are presented along with correlation with the pathological specimens. The combination of the findings in sonography and computed tomography in this condition enables one to make an accurate preoperative diagnosis. Calyces containing pus and/or xanthomatous tissue produced low-level echoes simulating preservation or thickening of the renal parenchyma on sonography. On CT the central low attenuation areas either gave negative values representing abundant xanthomatous tissue seen on gross pathology, or measured in the water density range representing a combination of pus and less abundant xanthomatous tissue.

Angiography in Inflammatory Space-Occupying Lesions of the Kidney

Renal and perirenal abscesses are relatively uncommon conditions which usually present a difficult diagnostic problem. In the majority of the 210 cases reported to date, the correct diagnosis has not been considered preoperatively despite the detection of a renal mass by intravenous urography (3, 8). Urinalysis is often unrevealing, and there are few if any early localizing signs or symptoms. With the increasing utilization of arteriography in the evaluation of lesions of the kidney, abscess should now be included as a serious consideration among the differential possibilities. As there has been little written regarding the arteriographic findings in this condition (10), we have been prompted to present our experience with five patients seen at Montefiore Hospital between 1963 and 1965. Clinical Material The pertinent clinical, laboratory, and pathologic data are summarized in TABLE 1. A correct preoperative diagnosis was offered in CASES II and IV. In the remaining 3 cases, a diagnosis of renal inflammat...

Metastatic neoplasm to the kidney studied by computed tomography and sonography.

Surgicalue to the widespread use of CT for tumor staging and diagnostic workup, the discovery of metastatic neoplasm to the kidney has become a more frequent occurrence. Nine patients with metastatic carcinoma to the kidney have been studied by CT, including six by sonography. Carcinoma of the lung was the primary tumor in eight. Bilateral renal involvement was seen in all cases. The presentation of the clinical and radiologic findings in these cases with differential diagnosis is included.

Correlation of CT and ultrasound in the evaluation of renal lymphoma

In a series of 225 patients with lymphoma studied by computed tomography, involvement of the kidney(s) was found in 11 (4.9%). These cases were then also studied by ultrasound. Because of the characteristic findings of computed tomography and sonography in renal lymphoma, a reliable diagnosis was possible along with an accurate assessment of the incidence and types of renal involvement. Illustration of this material along with a discussion of the clinical implications of these findings is presented.