Surgical clips are identified in the left renal fossa. The right kidney appears unremarkable. A 20 gauge Chiba needle was directed into one of the left retroperitoneal soft tissue masses. Sample was sent for analysis. Metastatic renal cell carcinoma to para-aortic node.
Differential diagnosis includes a complicated cyst, an angiomyolipoma.
In addition one may see inhomogeneity secondary to hemorrhage, necrosis, or cystic degeneration. MRI is the best modality to assess either Stage III or Stage IV disease. One may see a low to medium signal intensity on the T1 weighted images. Hyperintense areas are usually due to hemorrhage. In addition on the T2 weighted images one may see heterogenous signal intensity.