Diagnostic ultrasound ( PDFDrive )

CHAPTER 9 The Kidney and Urinary Tract 355
A
B
FIG. 9.64 Renal Metastases (Lung Primary). (A) Sagittal sonogram shows iniltrating, mixed-echogenicity tumor throughout the upper pole
of the kidney. (B) Contrast-enhanced CT demonstrates bilateral iniltrating metastases.
A
B
FIG. 9.65 Bladder Metastasis From Gastric Adenocarcinoma. (A) Transverse suprapubic sonogram shows a papillary solid intraluminal mass
with obvious bladder wall involvement. (B) Conirmatory transvaginal scan shows the papillary nature of the tumor to better advantage.
at ultrasound is nonspeciic; a solid mass may be seen in the
bladder wall (Fig. 9.65).
Urachal Adenocarcinoma
he urachus measures 3 to 10 cm in length and represents the
obliterated remnant of the allantois. It is lined by transitional
epithelium. he urachal remnant is divided into supravesical,
intramural, and intramucosal portions. Urachal neoplasms are
rare, usually arising in the upper part of the intramural portion
of the urachal remnant or in the lower part of the extravesical
portion of the bladder. 226 Urachal cancers represent 0.01% of all
adult cancers, 0.17% to 0.34% of all bladder cancers, and 20% to
39% of all primary bladder adenocarcinomas. 227 About 75% of
urachal cancers occur in men. 228 Most tumors arise at the bladder
dome at the vesicourachal junction. Urachal tumors have a poor
prognosis and tend to invade the anterior abdominal wall. Most
patients present with hematuria, although other common
symptoms include frequency, dysuria, and mucosuria. 228 At
sonography, a bladder dome mass is seen, oten calciied (50%-
70%). he mass may be solid, cystic, or complex cystic-solid.
Tumor extension into the perivesical fat, space of Retzius, and the
abdominal wall is common. Local recurrence ater resection is
common.
Rare Neoplasms
Kidney
Juxtaglomerular tumors are rare benign tumors that more
frequently afect women. Renin secretion by these lesions results
in hypertension. At sonography, they are usually small, solid,
and hyperechoic. 229 Excision will alleviate the hypertension.
Leiomyomas are benign tumors that arise from the renal capsule.
hey are usually discovered incidentally but may grow large
enough to become clinically evident. On sonography, a solid,