Question:

Possible imaging finding of pseudotumorous renal sarcoidosis include:
1. Well-circumscribed borders as seen on MR
2. Early enhancement to a lesser degree than surrounding normal renal parenchyma on venous phase post-contrast T1 imaging
3. Hypoenhancement on contrast-enhanced CT
4. Lesions of differing imaging quality in other abdominal organs or lymph nodes
5. Decreased radiotracer uptake on PET using 18F-FDG





Answer:

The correct answer for the question "Possible imaging finding of pseudotumorous renal sarcoidosis include:" is:

3. Hypoenhancement on contrast-enhanced CT



Explanation
1. Pseudotumorous masses are [poorly circumscribed on MR] which likely indicates a poorly marginated zone of transition between the mass and parenchyma, indicating likely interstitial involvement.

2. [There was mild contrast enhancement on initial arterial phase imaging and subtraction imaging, however it demonstrated slower enhancement than the remainder of the renal cortex.]

3. This answer is the applies one, as the pseudotumors [are focal, exophytic nodules that are hypo-enhancing on contrast-enhanced CT…], not hyper-enhancing.

4. Involvement of other abdominal organs is more likely, and can occur simultaneously with renal involvement. [Sarcoid manifestations in the liver and spleen are the most common intraabdominally… nonspecific imaging qualities are similar to those of malignant metastases and lymphoma, and tissue biopsy is necessary for differentiation.]

5. [Whole-body PET using 18F-FDG has been performed  and demonstrated intense radiotracer uptake by such masses, which limits its value because of the inability to differentiate such masses from malignancies.]



From the manuscript:
Sarcoidosis Manifesting as a Pseudotumorous Renal Mass
Radiology Case. 2013 May; 7(5):23-34


This article belongs to the GU section.




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From the manuscript

Sarcoidosis Manifesting as a Pseudotumorous Renal Mass

Free full text article: Sarcoidosis Manifesting as a  Pseudotumorous Renal Mass

Abstract
A 53 year-old African American woman with a three-year history of pulmonary sarcoidosis had a follow-up computed tomographic scan to evaluate the status of her disease and response to treatment. On the scan, an abnormal, hypodense mass on the left renal superior pole, which was not present on previous scans, was incidentally discovered. The initial concern was of carcinoma, despite her lack of any urinary symptoms. She underwent further evaluation with magnetic resonance, and the enhancement pattern and the shape of the mass were more suggestive of lymphoma or infarction than a carcinoma. A review of literature revealed sparse case reports demonstrating sarcoidosis presenting as infiltrative granulomatous masses resembling tumors with nonspecific imaging qualities. This diagnosis was entertained and then proven by biopsy. Pseudotumorous renal sarcoid should be in the differential of renal masses, especially in patients with a history of sarcoidosis, as it alters clinical management.






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