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DIFFERENTIAL DIAGNOSIS

OF A RENAL MASS

BY
Nasr El-Tabey
Assistant professor of Urology
Urology and Nephrology Center
Mansoura-Egypt
Differential Diagnosis

Congenital
Traumatic
Inflammatory
Neoplastic
Others
Congenital

Polycystic kidney
Pelviureteric junction obstruction
Multicystic dysplastic kidney
PUV causing hydronephrosis
Traumatic
Perirenal urinoma
Perirenal hematoma
Inflammatory
Perinephric abscess

Intrarenal abscess

TB pyelonephritis
Neoplastic

Benign :Renal cyst


Angiomyolipoma
Oncocytoma
Malignant :RCC
Sarcoma
Lymphoma
Other causes
Hydronephrosis :Ureteric stone
Ureteric stricture
Ureteric tumor
Reflux
Chronic retention
How to reach the diagnosis

History

Examination

Investigations
History

Age :
Children :congenital causes,Tumor,hydronephrosis
Adults : Hydronephrosis due to stones.
Old age : Tumors

Sex :
Renal tumors and stones are more common in male
Angiomyolipoma more in female
History
History of trauma

Associated symptoms :
Fever in perinepric abscess
Hematuria in renal tumors and trauma
Renal colic in hydronephrosis and stones
Examination
General examination :
Fever : eg. inflammatory cases
Pallor : eg. Trauma and tumors

Abdominal Examination :
Inspection
Palpation
Percution
Auscultation
Inspection
Echymosis and abrasions: in cases of trauma

Redness and pointing : in abscess

Diffuse bulge : in hydronephrosis and polycystic kidney.

Localized bulge : in renal tumor


Palpation
Bimanual examination
Palpation
Site : in the renal angle
Size : variable
Shape : variable
Surface : regular in hydronehrosis and tumors
irregular in polycystic kidneys
Consistency : solid in tumors
cystic in hydronephrosis and pck
Tenderness : in perinephric abscess
Investigations
Urine analysis : hematuria in tumors
Pus cells in abscess
crystals in stones

Blood picture : leucocytosis in abscess


Anaemia in tumors and trauma
metabolic abnormalities in stones
uremia if affected kidney function
Investigations
Radiological : KUB
IVP
US
CT
MRI
Isotopic study
KUB
Soft tissue mass

Obliteration of the psoas shadow

Ureteric stones

Tumor calcification
IVP
Soft tissue mass
Hydronephrosis and stones
Polycystic kidneys
PUJO
Assess the kidney function
US
Site
Size
Cystic or solid
Stones
CT
The most accurate
All criteria of the mass
The possible aetiology
Assess the kidney function
MRI
No additional advantages over CT

Indicated in high serum creatinine


ISOTOPIC SCAN
OF little value

Assess the kidney function


THANK YOU