Julia R. Fielding, M.D. Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts

37 Year-old Male with Flank Pain

This young man underwent CT scan and IVP that revealed a large 10 cm mass arising from the upper pole of the left kidney. MRI was performed to better characterize the mass prior to surgery.

Axial (Figure 1) and coronal (Figure 2) T1-weighted (600/10) images demonstrate the left renal mass and abnormal tissue adjacent to the aorta. Axial T2-weighted fat-suppressed (4000/108) (Figure 3) and gradient echo (33/13/30 degrees) (Figure 4) images show marked heterogeneity of the mass, likely indicating necrosis, and a patent left renal vein. The patient underwent radical nephrectomy. Pathologic analysis showed Wilm's tumor with direct extension into the periaortic tissue.