Contrast-Enhanced Ultrasound Evaluation of Papillary Renal Cell Carcinoma

Renal cell carcinoma (RCC) comprises approximately 90% of malignancy in the kidney. Early stage RCC is often asymptomatic. The majority of RCC are incidentally found on imaging ordered for unrelated medical indications. When diagnosed at an early stage, the survival or even cure rate is high. With more progressive stages, the outcome is less favorable. Tumor-induced angiogenesis affects blood flow in tumors such that patterns of perfusion can be utilized for diagnosis. Contrast-enhanced ultrasound (CEUS) takes advantage of the vascular architecture and provides a real-time assessment of vascularity, helping differentiate between solid and cystic masses. CEUS is a favorable tool for evaluation of indeterminate renal lesions due to its specificity for solid enhancing components, safety profile, and relatively low cost when compared with other imaging modalities including computed tomography (CT) or magnetic resonance imaging (MRI). This case highlights the sensitivity of contrast-enhanced ultrasound for detecting blood flow in a patient with papillary RCC.