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Hyperdense renal masses: a computed tomographic dilemma.

B G Coleman, P H Arger, M C Mintz

    AJR. American Journal of Roentgenology
    |August 1, 1984
    PubMed
    Summary
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    High-density renal masses on computed tomography (CT) present a diagnostic challenge. This study found that these masses can be malignant neoplasms or complicated hemorrhagic cysts, guiding management strategies.

    Area of Science:

    • Radiology
    • Urologic Oncology
    • Pathology

    Background:

    • High-density renal masses on computed tomography (CT) are atypical and pose diagnostic challenges.
    • Differential diagnosis primarily includes complicated benign cysts and malignant neoplasms.

    Purpose of the Study:

    • To analyze CT findings of discrete, sharply marginated renal masses with high attenuation values (≥50 HU).
    • To determine the underlying pathologic entities responsible for these high-attenuation lesions.
    • To describe an approach to therapeutic management.

    Main Methods:

    • Retrospective analysis of 17 cases with high-density renal masses on CT.
    • Correlation of CT findings with subsequent pathologic diagnoses or clinical follow-up.
    • Review of imaging characteristics and patient outcomes.

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    Main Results:

    • Pathologic confirmation revealed primary malignancies in six patients and hemorrhagic cysts in four.
    • One patient had malignancy with coexisting proteinaceous retention cysts.
    • Six patients lacked histologic proof; two with presumed hemorrhagic cysts showed stability on serial CT.

    Conclusions:

    • High-attenuation renal masses on CT require careful evaluation to differentiate between malignancy and complicated cysts.
    • Pathologic correlation and serial imaging are crucial for accurate diagnosis and management.
    • A structured approach to management is essential for these challenging lesions.