Lymphoma of the kidneys: unusual ultrasound appearance due to infiltration of the renal sinus

The role of ultrasound in renal insufficiency: the essentials

Sonography is the best screening modality to evaluate patients presenting with renal insufficiency. Ultrasound findings can be normal in patients with renal disease, especially in prerenal azotemia and acute parenchymal renal disease. Echogenic kidneys indicate the presence of parenchymal renal disease; the kidneys may be of a normal size or enlarged. Small kidneys suggest advanced stage chronic kidney disease. Uncommonly, cystic disease of the kidney, especially adult type polycystic kidney disease may be the cause of the patient's renal insufficiency with bilaterally enlarged kidneys containing multiple cysts of various sizes. If hydronephrosis is present, the level and cause of the obstruction should be sought. When ultrasound cannot diagnose the level and cause of obstruction, other imaging modalities, including CT and MRI may be useful. When renovascular disease (arterial stenosis or venous thrombosis) is suspected, spectral and color Doppler can be useful in detecting abnormalities.

Diagnostic imaging in the evaluation of renal lymphoma

Renal lymphoma usually is a manifestation of disseminated disease and often is asymptomatic. Occasionally, the kidney(s) may be the major or only demonstrable site of disease, which may then present with a variety of urologic symptoms. The imaging studies should be tailored according to the presenting symptoms and prior history. Currently CT with intravenous contrast material enhancement is the study of choice for both the evaluation of renal involvement as well as staging of the disease. When necessary, CT or sonography may be used to guide percutaneous needle biopsy of suspicious masses. The role of the various imaging techniques, including MR and positron emission tomography, in the evaluation of renal lymphoma is discussed.

Mass effect in the renal sinus: an anatomic classification

Before the advent of modern imaging techniques, pathologic processes in the renal sinus were diagnostic enigmas. Many of the conditions create nonspecific deformities of the contrast-filled collecting system. In the past, the discovery of these abnormalities often led to unnecessary exploration. Modern imaging techniques usually allow a specific diagnosis to be made, but because a number of the pathologic conditions affecting the renal sinus have similar appearances on a single type of imaging study, complete delineation may require correlation of a number of diagnostic techniques. An understanding of the normal sinus anatomy allows classification of pathologic processes that occur in this region and ensures an orderly imaging investigation. The anatomic classification is based on the structure from which the mass arises. The source of the mass may be any structure within the renal sinus (intrinsic), the enveloping renal parenchymal (adjacent), or a source outside the kidney itself with subsequent sinus involvement (extrinsic). This classification will be used to review a number of pathologic processes that occur in the renal sinus and pertinent imaging features.

Ultrasound of extranodal abdominal lymphoma--a review

Ultrasound is a valuable method for the detection of abdominal lymph node involvement in malignant lymphoma. In this review the characteristic patterns of organ involvement with lymphoma are described, the features compared with other pathologies and the appearances correlated with histological findings.

Castleman's disease with vascular encasement and renal sinus involvement

Castleman's disease is a relatively rare entity. Approximately 4% of cases are located in the retroperitoneum or pelvis. The plasma cell variety accounts for 10% of all cases of Castleman's disease. A case of the plasma cell variant involving the renal sinus and retroperitoneum is presented.

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.