Case Presentation SGH July 2008. Lauren Eisenberg. CC/HPI. CC: L flank pain
Case Presentation SGH July 2008
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HPI: 41yo AAM presents to ED with c/o abd and L flank pain for 5days. Pain described as intermittent, excruciating, sharp, radiates from flank to lower LLQ. Nothing improves or worsens pain. Associated with decrease urine output, decrease stream, and concentrated urine.
PMHx: diverticulosis, HTN, anxiety disorder
M: Paxil 30mg qday, Maxzide
Mother: HTN, Polycystic Kidney Disease
Father: Dialysis for DM
SoHx: married w/ 6 children, No ETOH/tob/IVDU
Neg: F/C/Weight loss
Gu: hematuria, dysuria
BP 148/101 P91 RR20 T35.9
Heent: normocephalic, EOMI
CV: RRR w/o m/g/r
Abd: soft, ND, mild L flank & LLQ TTP with deep palpation
GU: b/l descended testicles, circumcised penis
Rectal: slightly enlarged, symmetrical, rubbery, no nodules
Chemisty Liver Profile
Na 140 AST 34
K 4.1 ALT 17
Cl 99 Alk Phosph 92
Hematology UA neg
CT abd/pelvis without contrast
1. Large mass off the left kidney with internal calcifications is highly suspicious for malignancy. Numerous small areas of mildly increased density are seen within the left and right kidney. Further evaluation with an IV contrast study is recommended.
2. No obstructing renal calculus or hydronephrosis on either side.
3. One prominent lymph node in the pericaval region. There is no lytic or destructive lesion within the visualized bones.
CT abd/pelvis w/ contrast
1. Large heterogeneous mass off the left kidney enhances strongly but then has early washout. This is suspicious for a renal cell carcinoma until proven otherwise.
2. Multiple other areas in both the right and left kidneys have either complex cysts, internal septations, or areas of nodular enhancement. These areas could represent multifocal areas of cancer. Further evaluation by MRI.
3. The renal veins are patent. No lytic or destructive lesion is seen within the visualized bones.
1. Large left renal mass, likely renal cell cancer.
2. There is a right enhancing renal mass highly suspicious for either primary renal cell cancer or metastases to the contralateral kidney
3. There are suspicious-appearing cysts with septations within both kidneys.
4. no evidence for invasion of the renal veins.
5. appears to be an adenoma within the right adrenal gland
1. A 6.5-cm mass in the anterior mid left kidney highly suggestive of renal carcinoma. no invasion of the left renal vein suggested.
2. Multiple additional small neoplastic lesions are suggested in the left kidney
3. A 2-cm simple cyst is seen in the lateral posterior right kidney, with an additional smaller lesion laterally suspicious for cystic neoplasm. A small hemorrhagic cyst is seen in the posteroinferior right kidney. There is a central lobulated mass in the renal pelvis region on the right which may represent multiloculated cyst or cystic neoplasm. Two additional smaller areas in the central right kidney are suspicious for cystic mass with peripheral enhancement.
2-3% adult malignancies
31,000 new cases/yr
10-20% increased incidence in AA
Incidence ↑ d/t use of US and CT
25-33% mets at initial presentation
Environmental Risk= tobacco
workers in metal, rubber, chemical, printing industry
Exposure to asbestos, cadmium
Vit A & E factory workers
Long standing obesity, low socioeconomic status, urban