This patient presented with left loin pain and haematuria.
At the lower pole of the left kidney is a large, slightly lobulated heterogenous but predominantly hyperechoic lesion. It measures 52 x 55 x 46mm.
Surrounding it as a more hypoechoic rim. This extends to the superior end of the kidney as a small perinephric collection and may represent a recent bleed.
This large echogenic lesion with a hypoechoic rim likely represents a renal cell carcinoma.
Angiomyolipomas are benign echogeinc renal tumours. There is significant overlap in the ultrasound appearance and CT is recommended to differentiate these two. AML contain fat and this is clearly evident on CT.
57% RCCs are echogenic and these tend to be larger, may have a hypoechoic rim or cystic spaces.
A recent review by Farrelly et al suggests all non-calcified echogenic renal lesions require CT for further evaluation.