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  1. Angiomyolipoma (Hamartoma)

Renal angiomyolipoma is a renal hamartoma composed of thick walled blood vessels, smooth muscles and fat.
It is isolated in 80% cases and associated with tuberous sclerosis in 20% cases.
Plain AXR may show fat lucency in the renal region.
USG may show intensely echogenic mass lesion.
CECT shows mass with fat density and highly vascular component.
Angiography is best investigation for diagnosis, which shows hypervascular mass.

  1. Wilms' Tumor
    The chief differential diagnosis for Wilms' tumor is neuroblastoma in which renal invasion may mimic Wilms' tumor. Patients with neuroblastoma present at a younger age than those with Wilms' tumor. Elevated catecholamines can be used to distinguish the two clinically. Features suggestive of neuroblastoma include an extrarenal epicenter, irregular shape, irregular margins, calcifications, particularly punctate or stippled, vascular encasement, extension across the midline, and the presence of hepatic or bony metastatic disease in the absence of pulmonary metastatic disease. Features favoring Wilms' tumor include an intrarenal epicenter, round or oval shape, well-defined margins, and vascular displacement or invasion.
  2. Key facts:
    A fixed filling defect in the urinary collecting system is highly suggestive of transitional cell carcinoma (TCC) and should be further evaluated with brush biopsy.
    QAn enhancing renal mass that does not contain macroscopic fat is a renal cell carcinoma until proven otherwise.
    An enhancing renal lesion with macroscopic fat is a benign angiomyolipoma.
    Cystic renal lesions that contain thick internal septations, thick mural calcification, or enhancing mural nodules are suggestive of cystic renal cell carcinomas and should be excised.
  3. American Association for the Surgery of Trauma renal Injury Grading Scale
Injury grade Description or CT finding
  1. Superficial laceration(s) involving cortex
  2. Renal contusion(s)
  3. <1 cm subcapsular haematoma
  4. Perinephric haematoma not filling Gerota's space and no
  5. Segmental renal infarction
  1. Deeper renal laceration extending to medulla, with intact collecting system
  1. > 1 cm subcapsular haematoma with intact renal function
  1. Perinephric haematoma limited to and not distending the perinephric space; no active bleeding
  1. Laceration extending into collecting system with urine extravasation limited to retroperitoneum          
  2. Perinephric haematoma distending perinephric space or extending into pararenal spaces; no active bleeding
  1. Fragmentation (three or more segments) of the kidney (usually partially devitalized with large perinephric haematoma
  2. Devascularization > 50% of parenchyma
  3. Main renal pedicle injury
  4. Active bleeding by CT
  5. Extravasation of urine into peritoneal cavity or extensive extravasation
  6. Subcapsular haematoma compromising renal perfusion

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