Incidental finding of renal cell carcinoma

Case contribution: Dr Radhiana Hassan


  • A 41 years old male
  • Underlying hypertension, fatty liver disease and DM
  • Presented with sudden onset of loss of consciousness with left sided body weakness
  • No trauma, no fever, no fitting episode, no vomitting
  • Clinically GCS=15/15, BP=205/125mmHg, other vital signs were normal. Left hemiparesis.
  • Diagnosed as hypertensive emergency
  • An urgent CT brain was requested to rule out intracranial hemorrhage
Non-contrast CT brain in axial planes

CT scan findings:

  • There is a large intraparenchymal hemorrhage at right frontotemporoparietal region measuring 4.4 x 4.7 x 3.7 cm (AP x W x CC) with minimal perilesional oedema.
  • Effacement of adjacent right lateral sulcus.
  • Midline shift to the left is noted measuring 0.5 cm.
  • There are 2 well defined cystic lesions at right frontal region. They are closely attached together with cumulatively measure 3.8 x 4.3 x 4.2cm (APxWxCC).
  • No calcification within the lesion

Progress of patient:

  • Further examination shows ballotable right kidney
  • Non tender, no other positive findings
  • Patient has no genitourinary symptoms
CT scan of abdomen in axial plane soft tissue window

CT scan abdomen in coronal plane soft tissue window post contrast

CT scan findings:

  • An enhancing mass arising from the lower pole of the right kidney (white arrows) measures about 5.5 cm x 5.7 cm x 6.0 cm.
  • Presence of central necrosis.
  • No fat or calcification is seen within.
  • The mass is seen touching the right Zuckerkandl fascia. However, no extension of the mass beyond this fascia is seen.
  • Clear but thin plane of separation is still observed between the mass and the lateral margin of the right psoas muscle.
  • A large necrotic node seen at the right renal hilar (yellow arrow) measures 2.7cm (short axis). No other enlarged abdomino-pelvic node detected.
  • No renal vein or inferior vena cava thrombosis is detected.
  • No hydronephrosis bilaterally.

Diagnosis: Renal cell carcinoma (presumed diagnosis) as patient refused further intervention.


  • Renal cell carcinomas are primary malignant adenocarcinomas derived from the renal epithelium and the most common malignant renal tumour.
  • It is also known as hypernephroma.
  • It occurs in 50-70 years old patients.
  • The most common presentation is macroscopic hematuria, flank pain and palpable flank mass
  • Risk factors include cigatette smoking, dialysis-related cystic disease, obesity, hypertension and post renal transplant
  • Ultrasound shows wide sonographic features and vary from solid to cystic lesion.
  • On non-contrast CT, lesions are of soft tissue density with larger lesions contain areas of necrosis. About 30% demonstrate some calcification.
  • On corticomedullary phase it is usually enhanced less than normal renal cortex. Larger lesions shows irregular enhancement with areas of necrosis.
  • Intraluminal growth in renal vein seen in about 4-15% of cases. IVC involvement indicate worse prognosis.


Author: radhianahassan