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1. Bilateral Wilms tumors

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Figure 49-1

Bilateral Wilms tumors.

CT of a child with aniridia demonstrates multifocal bilateral renal masses, some of which have nonenhancing areas of necrosis. Residual renal parenchyma has greater enhancement than the neoplasms.

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2. Multicentric Wilms tumor

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Figure 49-2

Multicentric Wilms tumor.

There are 3 homogeneous leftrenal masses on this longitudinal sonographic image of a 15-month-old child.

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3. Wilms tumor

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Figure 49-3

Wilms tumor.

A longitudinal sonographic image shows an oval mass that is slightly hyperechoic relative to the adjacent normal renal parenchyma. This small Wilms tumor has only minimal sonographic heterogeneity.

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4. Wilms tumor

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Figure 49-4

Wilms tumor.

A. An axial contrast-enhanced CT image of a 5-year-old child with a palpable flank mass demonstrates a large, somewhat heterogeneous renal mass. The lesion is hypoattenuating relative to the enhancing renal parenchyma anterior and medial to the mass. Thinned parenchyma envelops the margin of the mass (arrows), helping to confirm a renal origin, that is, the "claw sign." B. The remaining renal tissue is along the superior medial aspect of the neoplasm, as visualized on this coronal CT image. The tumor has a heterogeneous enhancement pattern and there are poorly enhancing central areas of necrosis. Despite the large size of this tumor, the margins are well defined and there is no vascular encasement.

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5. Wilms tumor

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Figure 49-5

Wilms tumor.

Coronal contrast-enhanced CT of a 5-year-old child with a palpable flank mass shows a large right kidney neoplasm with extension of tumor thrombus (arrow) into the inferior vena cava and right atrium.

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6. Mesoblastic nephroma

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Figure 49-6

Mesoblastic nephroma.

There is a large leftflank mass in this 2-day-old infant.

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7. Rhabdoid tumor

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Figure 49-7

Rhabdoid tumor.

This 5-year-old boy presented with hematuria and a palpable right flank mass. A. Sonography shows a large heterogeneous mass with well-defined peripheral margins. B, C. The lesion is also heterogeneous on contrast-enhanced CT. There are crescentic hypoattenuating subcapsular fluid collections (arrows). The residual enhancing renal parenchyma is stretched around the periphery of the mass. D. There are metastatic nodules in the right lower lobe.

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8. Renal cell carcinoma

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