Imaging Pearls ❯ Kidney ❯ Renal Tumor Surgery: Pre op and Post op Findings
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- “Fat retention in the bladder after partial nephrectomy can be observed using CT, although it is relatively rare. It is clinically asymptomatic and disappears spontaneously in most cases.”
CT detection of fat retention in the bladder after partial nephrectomy Kazaoka, J., Kusakabe, M., Ottomo, T. et al. Abdom Radiol (2017). doi:10.1007/s00261-017-1117-4 - Fat Retention in the Bladder: Causes
• Chyluria
• Transurethral inlection of oil or lubricants
• Iatrogenic
• Filariasis
• s/p Partial Nephrectomy - “Partial nephrectomy is clearly indicated in the guidelines as the standard operative procedure for small renal cell carcinoma, and it shows no difference in long-term cancer control when compared with radical nephrectomy . In a previous study investigating the complications associated with partial nephrectomy and radical nephrectomy, the number of complications associated with the genitourinary system (mostly urinary leakage) was significantly higher in the partial nephrectomy group, although there was no significant difference in the overall incidence of complications between the two groups. Other than urinary leakage, perinephric abscess, acute renal failure, retroperitoneal hemorrhage, and pseudoaneurysm formation are the known complications of partial nephrectomy.”
CT detection of fat retention in the bladder after partial nephrectomy Kazaoka, J., Kusakabe, M., Ottomo, T. et al. Abdom Radiol (2017). doi:10.1007/s00261-017-1117-4 - Partial Nephrectomy: Complications
• urinary leakage
• perinephric abscess
• acute renal failure
• retroperitoneal hemorrhage
• pseudoaneurysm formation
• chyluria
- “Following nephrectomy, approximately 20%-40% of patients will develop recurrence. Most will develop recurrence within 2-4 years of nephrectomy. One characteristic of renal cell carcinoma is the development of metastases many years after surgical treatment. According to one recent study, 6.4% of patients developed metastases 10 years after their initial surgery. The rate of recurrence and the time to recurrence after nephrectomy is dependent on the stage of the tumor. The lower the stage of the tumor, the lower the rate of recurrence and the longer the time between initial treatment and recurrence.”
MDCT imaging following nephrectomy for renal cell carcinoma: Protocol optimization and patterns of tumor recurrence
Coquia SF, Johnson PT, Ahmed S, Fishman EK
World J Radiol. 2013 Nov 28; 5(11): 436–445. - “One recent study reviewed the utility of the dual phase abdominal CT in the detection of renal cell carcinoma metastases. About 75% of the lesions were visualized in the arterial phase and in 9% of patients lesions were only visible in the arterial phase. These lesions were located in the liver, pancreas, and kidney.”
MDCT imaging following nephrectomy for renal cell carcinoma: Protocol optimization and patterns of tumor recurrence
Coquia SF, Johnson PT, Ahmed S, Fishman EK
World J Radiol. 2013 Nov 28; 5(11): 436–445. - “The lung is the most common site of recurrence and often the earliest site of recurrence. Chae et al reported in their study of post-operative recurrence after nephrectomy that the lung was the first site of recurrence in 56% of patients. The appearance of the metastases may be well defined, rounded nodules of varying size or be irregular in shape. They may be singular or multiple. On soft tissue windows, these metastases may enhance as brightly as the pulmonary vasculature. If they are large enough, they may show central necrosis.”
MDCT imaging following nephrectomy for renal cell carcinoma: Protocol optimization and patterns of tumor recurrence
Coquia SF, Johnson PT, Ahmed S, Fishman EK
World J Radiol. 2013 Nov 28; 5(11): 436–445. - “After nephrectomy, the incidence of adrenal metastasis has been reported as high as 10%. A study by Weight et al. regarding the utility of ipsilateral adrenalectomy at the time of nephrectomy reported an incidence of 3.7% for asynchronous adrenal metastasis after surgery. A normal adrenal gland on CT has a 100% negative predictive value for tumor involvement. As with local recurrence, adrenal metastases can be quite small and may only be seen on arterial phase. Owing to their vascularity, they can mimic adrenal adenomas in showing washout.
MDCT imaging following nephrectomy for renal cell carcinoma: Protocol optimization and patterns of tumor recurrence
Coquia SF, Johnson PT, Ahmed S, Fishman EK
World J Radiol. 2013 Nov 28; 5(11): 436–445.
- “ Approximately 20-30% of patients with surgically treated localized RCC will eventually develop distant metastatic recurrence. The most common sites of metastatic spread are the lungs, lymph nodes, bones, liver and brain.”
Imaging in the Follow-Up of Renal Cell Carcinoma
Patel U, Sokhi H
AJR 2012; 198:1266-1276 - Patterns of Metastatic Renal Cell Carcinoma: Autopsy Series
- Lungs (40-65%)
- Lymph nodes (16-47%)
- Bone (19-40%)
- Liver (16-27%)
- Kidneys (2-24%)
- Adrenal gland (3-24%)
"CT has an important role in postoperative evaluation of patients with urinary diversion to identify correctablle causes early to prevent deterioration in renal function and detect tumor recurrence in patients who had bladder cancer."
Role of CT in Postoperative Evaluation of Patients Undergoing Urinary Diversion
Kawamoto S, Fishman EK
AJR 2010; 194:690-698- Post Partial Nephrectomy CT Findings (normal)
- Kidney displacement
- Perinephric fat stranding
- Parenchymal defect
- Non fat containing post operative collection
- Significant more posterior renal displacement "While almost all postoperative cllections decrease in size or completely resolve over time, collections after laprascopic surgery may persist longer, some up to 3 years."
Laparascopic and Open Partial Nephrectomy: Frequency and Long-term Follow-up of Postoperative Collections
Hecht EM et al.
Radiology 2010; 255:476-484"Prevalence of findings 2-3 years after partial nephrectomy depends on the surgical approach. After laparoscopic partial nephrectomy, collections are more frequently detected on images and may take longer to resolve than following an open approach."
Laparascopic and Open Partial Nephrectomy: Frequency and Long-term Follow-up of Postoperative Collections
Hecht EM et al.
Radiology 2010; 255:476-484