RSNA2018读片会病例挑战（6）：63岁女性，右腹痛，体重下降5kg，既往有长期癫痫史

Thought Process

1. Ultrasound was very helpful, thanks for that

2. Renal vs. perirenal have very different DDx

3. Seizures imply a neuro-oncologic syndrome

4. Multi-year = probably not mets

5. “Guess that mass” always seemed odd to me

Why bother thinking?

2018 RSNA

Image Interpretation Session

Abdomen: GU

History

63 year-old female with:

• right abdomen/flank pain

• long standing history of seizures

• 5.0 kg unintentional weight loss

Ultrasound Found:A thing.

CT shows: Large bilateral solid perinephric masses

Iso, no fat attenuation 

Just bowel 

Just bowel

No nodes，Solid，Extrarenal

Volume averaging?

Normal adrenals

Fat plane

Nothing perineural

Normal

skin

Normal

skin

Thought Process

1. Ultrasound was very helpful, thanks for that

2. Renal vs. perirenal have very different DDx

3. Seizures imply a neuro-oncologic syndrome

4. Multi-year = probably not mets

5. “Guess that mass” always seemed odd to me

Why bother thinking?

Perirenal Differential Diagnosis

Perirenal

Lymphoma or mets

Histiocytosis conditions

Plasmacytomas

Paragangliomas

Extramedullary

Hematopoesis

Erdheim Chester

Mass-forming IgG4

Neuro-Oncologic Differential Diagnosis

Perirenal

NF-1

vHL

Many others

Tuberous Sclerosis

Some AMLs nasty: Epithelioid AMLs (aggressive)

Final Differential and Plan

Reasonable possibilities

--Fat-poor epithelioid AMLs in setting of TS

--Histiocytosis (Rosai-Dorfman [non-Langerhans cell])

--Lymphoma

--Paragangliomas

--Mass-forming IgG4

Plan:

Look at chart (do they have TS?)

Comparisons (esp. CNS)

Metanephrines – if above (-)

Set up for biopsy

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FROM：http://archive.rsna.org/2018/Final%20Unknown%20Cases%2011.12.18.pdf