Renal Cell Carcinoma

Clinical History: 
This is a 76 year old man who was admitted to the hospital for sharp chest pain and was incidentally thought to have splenomegaly on physical exam. An abdominal ultrasound was initially ordered. The spleen appeared normal but a lesion in the lower pole of the left kidney was identified, for which a follow up MRI was performed. The patient did not have any genitourinary symptoms.

Diagnosis:
Renal cell carcinoma involving the left kidney with probable metastases to the adrenal glands.

MR Technique: 
3 T scanner (Siemens Verio) using a body matrix coil. Image 1: axial FSE T2-weighted BLADE scan with fat saturation (TS/TE 4597/83 ms, scan time 41 sec, slice thickness 5 mm); Image 2: axial 3D breath hold T1-weighted scan (VIBE) performed with fat saturation (TR/TE 3.9/1.3 ms, scan time 12 sec, slice thickness 4 mm); Image 3: axial 3D breath hold T1-weighted scan (VIBE) performed with fat saturation (TR/TE 3.9/1.3 ms, scan time 12.7 sec, slice thickness 4 mm) after injection of 0.1 mmol/kg of gadolinium chelate; Image 4: coronal breath hold post-contrast VIBE scan (TR/TE 5.5/2.5 ms, scan time 36 seconds, slice thickness 3 mm).

Imaging Findings:
The MR examination reveals an approximately 4.6 x 4.6 cm enhancing soft tissue mass arising from the inferior pole of the left kidney, with patency of the left renal vein. Both adrenal glands are enlarged. The right adrenal gland measures 9.0 x 5.0 cm, and shows slightly heterogeneous enhancement. The left adrenal gland measures 6.3 x 4.0 cm, with minimal enhancement. T2 signal is iso- to slightly hyperintense. No drop of signal is observed on out-of-phase images to suggest lipid content.