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SIGNOS UTILES MASAS SIGNOS UTILES MASAS SOLIDAS SOLIDAS CICATRIZ CENTRAL ONCOCITOMA

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  • SIGNOS UTILES MASAS SOLIDASCICATRIZ CENTRALONCOCITOMA

  • SIGNOS UTILES: CICATRIZ CENTRAL LA CICATRIZ NO ES ESPECIFICA DE ONCOCITOMAONCOCITOMA CARCINOMA

  • GUIA DE SUPERVIVENCIA PARA MASAS RENALESTAKE HOME (5)

    1- GRASA MACROSCOPICA considerar AML

    2- AML con mnima o no grasa considerar si HIPERdenso en TC sin contraste, realce homogneo, HIPOintenso en T2 y CAE DE SEAL en FASE OPUESTA

    3- GRASA Y CALCIO considerar CCR

    4- CICATRIZ CENTRAL considerar Oncocitoma (pero no descartar CCR)

  • 2. PATRON DE REALCECCR Papilar son tpicamente hipovasculares y homogneos.

  • 3. PATRON AFECTACION

    EXPANSIVO

    CystAngiomyolipomaOncocytomaMultilocular Cystic NephromaFocal PyelonephritisRCCMetastasesLymphoma

  • 3. PATRON AFECTACIONINFILTRATIVO

    Infiltrating tumorTCCLymphomaSCCMetastasesrarely RCC

    Infection: Focal pyelonephritisInfarction

  • PATRON INFILTRATIVOSQUAMOUS CELL CARCINOMALYMPHOMA 5-year-oldINFILTRATIVE RCC

  • PATRON INFILTRATIVOSENO RENAL Transitional cell Ca (TCC)Lymphoma

    PARENQUIMALymphomaInfiltrating RCCMetastasesCCTEVALUAR EPICENTRO

  • PATRON INFILTRATIVOCCT CCTs afecta sistema colector.CCTs Agresivos pueden afectar el seno y el parnquima

  • PATRON INFILTRATIVOLINFOMALINFOMA frecuentemente infiltra el rin va el seno renal y/o afecta el espacio perirrenal

  • 3. PATRON AFECTACIONBetchold RE. The perirenal space: Relationship of Pathologic Processses to normal retroperitoneal anatomyRadiographics, 1996; 16: 841-854

    PERIRRENAL

    LymphomaRCCMetastases (Lung, RCC, melanoma)InfectionHemorrhage

  • AFECTACION PERIRRENALLYMPHOMAABSCESSRCCLUNG Ca - METASTASESHEMORRHAGIC CYST

  • GUIA DE SUPERVIVENCIA PARA MASAS RENALESTAKE HOME (6)

    1- INFILTRATIVO considerar CCT y LINFOMA

    2- EXPANSIVO descartar CCR

    3- PERIRRENAL considerar METASTASIS y LINFOMA

  • TAKE HOME (7)MANEJO de una MASA SOLIDAEXTIRPALAO BIOPSIALASlo AML: SIGUELOGUIA DE SUPERVIVENCIA PARA MASAS RENALES

  • MASASINDETERMINADAS

  • DEMASIADO PEQUEAS PARA CARACTERIZAR

    Pacientes de alto riesgo = RMVHLCCR PapilarPacientes de bajo riesgoOLVIDALO

  • Indeterminada en TC< 5-10 mmNo sntomasNo factores de riesgo

    Es un QUISTE SIMPLEOLVIDALO

    Zagoria RJ. Imaging of Small Renal Masses: A medical success storyAJR, 2000; 175: 945-955

  • ONCOCITOMASNo siempre es fcil...MULTIPLE CCRs???

  • 5-20%Masas Expansivas ExtirpadassonLESIONES BENIGNAS

    OncocitomaAML sin grasa detectableOtras lesiones rarasZagoria. RSNA 2005

  • Qu podemos hacer?Esclerosis Tuberosa. Masas renales bilaterales con realce homogneo.No signos radiolgicos de grasa

    Bipsialo...AML CON MNIMA GRASA!!!!

  • Biopsia PercutneaSilverman S. Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy. Radiology, 2006; 240: 6-22LYMPHOMA

  • Biopsia PercutneaSilverman S. Renal Masses in the Adult Patient: The Role of Percutaneous Biopsy. Radiology, 2006; 240: 6-22

  • GUIA DE SUPERVIVENCIA PARA MASAS RENALES2. MASAS QUISTICAS

    QUE DEBEMOS BUSCAR?

  • MASAS QUISTICASCATEGORIAS1- QUISTES SIMPLES2- QUISTES COMPLICADOS3- TUMORES QUISTICOS

  • QUISTES SIMPLESTC0 - 20 HUNo Enhancement

    USAnecoicoRefuerzo AcsticoOLVIDALO...!!

  • Usa los criterios de BOSNIAK or HARTMAN para decidir

    Para resolver problemas:> 1 cm US vs MDTC< 1 cm RMQUISTE PERO NO Q. SIMPLESMALL CYST

  • Bosniak Classification5%MALIGNOS50%MALIGNOSI A simple benign cyst with a hairline thin wall that does not contain septa, calcification or solid components. It measures as water density and does not enhance with contrast material.

    II A benign cyst that might contain a few hairline thin septa. Fine calcification might be present in the wall or septa. Uniformly high-attenuation lesions of < 3 cm that are sharply marginated and do not enhance.

    IIF These cysts might contain more hairline thin septa. Minimal enhancement of a hairline thin septum or wall can be seen and there might be minimal thickening of the septa or wall. The cyst might contain calcification that might be nodular and thick but there is no contrast enhancement. There are no enhancing soft-tissue elements. Totally intrarenal non-enhancing high-attenuation renal lesions of 3 cm are also included in this category. These lesions are generally well marginated.

    III These lesions are indeterminate cystic masses that have thickened irregular walls or septa in which enhancement can be seen.

    IV These lesions are clearly malignant cystic lesions that contain enhancing soft-tissue components.

  • QUISTES BOSNIAKRECORDAD, ES SOLO UNA CLASIFICACION CLINICA PARA DECIDIR SU MANEJO

    NO ES UNA GUIA ABSOLUTA!!

  • MANEJO DE UNA MASA QUISTICA I Q. SimpleII Minmamente Complicado

    IIF

    III - IndeterminadoIV Neoplasi QOLVIDALOSEXTIRPALOS oBIOPSIALOSSIGUELOS

  • Hiperdenso/HipersealCALCIFICACIONSEPTOSMULTILOCULAR (> 3-4)REALCENODULARIDADPARED GRUESAQUISTE PERO NO Q. SIMPLECUANDO?

  • QUISTE PERO NO Q. SIMPLEHIPERDENSO o HIPERSEAL>70 UH en TC SIN CONTRASTEQ. HEMORRAGICO

    Israel G. Radiology 2007

  • SEPTOSFINOS ( < 1mm) y LISOS (OLVIDALO...)vsIRREGULAR y REALCE (EXTIRPALO...)2 CCRs PapilaresQUISTE PERO NO Q. SIMPLE

  • NODULOSREALCE (EXTIRPALO...)vsPEQUEO y NO REALCE (SIGUELO...)CCRQUISTE PERO NO Q. SIMPLE

  • CCR Papilar - SEPTOS y NODULOS con realceQUISTE PERO NO Q. SIMPLEExtrpalo...Sustraccin

  • GROSOR DE PAREDGRUESA Y REALCE(EXTIRPALO...)

    RECUERDA...

    - Q. Infectado- Absceso- Q. hemorrgico- Hematoma

    Pueden tener pared Gruesa!!

    ABSCESOQUISTE PERO NO Q. SIMPLEQ. Complicado

  • CALCIFICACION1.DELGADA y No realceLechada clcica (OLVIDALO...)

    2.GRUESA Y NODULAR(SIGUELO...)

    3.REALCE, NODULARIDAD(EXTIRPALO... or BIOPSIALO...)QUISTE PERO NO Q. SIMPLECCR

  • MULTILOCULAR (>3-4 septos)EXTIRPALO...QUISTE PERO NO Q. SIMPLEEl diagnstico diferencial entre CCR Multilocular y Nefroma Multiqustico no es posible

  • MULTILOCULARPIONEFROSISPero...

    Enfs. Qusticas Renalesy las Lesiones Inflamatorias pueden aparecer como masas multiloculares.

    QUISTE PERO NO Q. SIMPLEENF. Q. LOCALIZADAENF. QUISTICA LOCALIZADAINFECCIONFISTULA ARTERIOVENOSA

  • CALCIFICACION GRUESA y NODULAR(No Realce)

    Q. HIPERDENSO> 3 cmTOTALMENTE INTRARRENALQ. COMPLICADOS MULTIPLES

    SEPTOS mayores que un pelo pero lisos Hartman DS. A practical aproach to the cystic renal mass.Radiographics, 2004; 24: S101-S115QUISTE PERO NO Q. SIMPLESEGUIMIENTO (II F)

  • Primer ao, cada 3-6 Meses

    Despus, cada ao

    STOP... > 5 aosHartman DS. A practical aproach to the cystic renal mass.Radiographics, 2004; 24: S101-S115QUISTE PERO NO Q. SIMPLESEGUIMIENTOCunto tiempo?

  • TAKE HOME (8)MASAS QUISTICAS SIGNOS SOSPECHOSOSQUISTES con hallazgos complejos- Septos Internas- Nodularidad - Pared Gruesa- Realce de paredms probablemente sern MalignosGUIA DE SUPERVIVENCIA PARA MASAS RENALES

  • ESTADIAJEMETASTASIS sin un Tumor Renal PrimarioEs muy raro, pero pueden aparecer metas sin primario y el primario aparecer despusCa Cels Claras. Metstasis. No tumor primario identificado en RIONES

  • NO CONFIARSE!!CCR (
  • Pequea masa en RICrecimiento en 3 meses

  • TAKE HOME (9)

    AVISO FINALGUIA DE SUPERVIVENCIA PARA MASAS RENALESLas masas deben ser manejadas en base a sus hallazgos radiolgicos ms agresivos

  • Listos para ser los radilogos expertos?

    *Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Insulinoma. Secuencia Turbo espn eco T2**Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Insulinoma. Secuencia Turbo espn eco T2**Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Althoug the low attenuation of basal ganglia and periventricular white matter resolved in 24 hours, thus related to edema secondary to acute hypertensive encephalopathy, a cerebral infarct at the level of the left internal capsula can be noted. Before the pheochromocitoma could be removed, a hemorrhage in the right internal capsula was developed. ******Althoug the low attenuation of basal ganglia and periventricular white matter resolved in 24 hours, thus related to edema secondary to acute hypertensive encephalopathy, a cerebral infarct at the level of the left internal capsula can be noted. Before the pheochromocitoma could be removed, a hemorrhage in the right internal capsula was developed. ***Lopez Verde*Lopez Verde**This is the case of a fifty-year-old woman admited for a well established Cushing syndrome. Biochemical background suggested an extradrenal tumor producing ectopic ACTH. A whole body enhanced CT scan was performed looking for a nonendocrine tumor, but the only pathologic finding was a round, 3-cm, left adrenal tumor which has central low attenuation. Note the hyperplasia of the contralateral adrenal, in contrast with the atrophic contralateral adrenal usually associated with a functional adrenal tumor causing Cushing syndrome. ***Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2**Adrenal hyperplasia occurs in 70% of patients with Cushings disease, and may result in difuse thickening of adrenal glands, but retention of the normal shape. This enlargement is usually smooth. *Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Althoug the low attenuation of basal ganglia and periventricular white matter resolved in 24 hours, thus related to edema secondary to acute hypertensive encephalopathy, a cerebral infarct at the level of the left internal capsula can be noted. Before the pheochromocitoma could be removed, a hemorrhage in the right internal capsula was developed. *Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*Insulinoma. Secuencia Turbo espn eco T2*T1 en fase*Insulinoma. Secuencia Turbo espn eco T2***T1 en fase*This is the case of a fifty-year-old woman admited for a well established Cushing syndrome. Biochemical background suggested an extradrenal tumor producing ectopic ACTH. A whole body enhanced CT scan was performed looking for a nonendocrine tumor, but the only pathologic finding was a round, 3-cm, left adrenal tumor which has central low attenuation. Note the hyperplasia of the contralateral adrenal, in contrast with the atrophic contralateral adrenal usually associated with a functional adrenal tumor causing Cushing syndrome.