Diagnostic ultrasound ( PDFDrive )

CHAPTER 9 The Kidney and Urinary Tract 347
urography is recommended to exclude neoplasm, particularly
in patients with hematuria (Fig. 9.54).
he sonographic appearance of renal TCC is variable and
depends on the morphology of the lesion (papillary, nonpapillary,
or iniltrative), location, size, and the presence or absence of
hydronephrosis (Fig. 9.55). Small, nonobstructing tumors may
be impossible to visualize at ultrasound. With growth, papillary
tumors will be seen as discrete, solid, central, hypoechoic renal
sinus masses with or without associated proximal caliectasis (Fig.
9.56). he diferential diagnosis includes blood clots, sloughed
papillae, and fungus balls.
Tumor iniltration within the renal pelvis or renal parenchyma
may be subtle. Findings suggestive of iniltrating TCC are distortion
and enlargement of the kidney and maintenance of an overall
reniform shape (Fig. 9.56). Sessile lesions are particularly diicult
to image directly by ultrasound, but the secondary inding of
an obstructing lesion (caliectasis, pelviectasis) is usually easily
depicted. A small subset of both sessile and papillary TCCs
may have dystrophic calciications, which makes it diicult to
diferentiate tumor from a sloughed, calciied papilla. 186 TCC
rarely invades the renal vein. 187
Ureteral Tumors
TCC of the ureter accounts for 1% to 6% of all upper urinary
tract cancers. 183,188 Men are afected more oten than women
(3 : 1). As with renal TCC, ureteral lesions are usually identiied
in older patients; peak prevalence of ureteral TCC is between
the ith and seventh decades. 183 he majority of tumors are found
in the lower third of the ureter (70%-75%). 183,188 About 60% of
ureteral TCCs are papillary and 40% nonpapillary. 183 he most
common symptoms are hematuria, frequency, dysuria, and pain. 188
he traditional imaging modalities of choice for evaluation of
ureteral TCC have included intravenous urography or retrograde
pyelography, but the advantages of multidetector CT urography
(ability to detect and stage even small urothelial lesions) have
been documented. 189,190 At sonography, hydronephrosis and
hydroureter are seen, and occasionally a solid ureteral mass may
be shown. 188
Bladder Tumors
TCC of the bladder is a common malignant tumor. Bladder
TCCs occur more oten in men (3 : 1), with a peak incidence in
A
B
C
FIG. 9.54 Iniltrating Upper-Pole Transitional Cell
Carcinoma (TCC). (A) Sagittal sonogram shows elongated
hypoechogenicity within the superior aspect of
the central sinus echo complex and subtle upper-pole
caliectasis. (B) Coronal reformatted contrast-enhanced
CT conirms iniltrating upper-pole TCC. (C) Preoperative
retrograde urogram shows irregular, amputated upper-pole
calyx.