Renal mass imaging: the internist's role.
The busy internist will encounter numerous renal masses when ordering nonurologic imaging. Concise and quick delineation of cystic from solid masses is necessary. Cystic masses constitute the majority of these masses and once their nature is diagnosed, they require no further work-up or referral. Often, a single imaging technique is unable to confidently establish the cystic nature of a renal mass. Proper selection of an additional imaging modality will often be successful in establishing the cystic characteristics of a benign mass. Referral to a urologist is not necessary in this setting, since the internist can coordinate the imaging evaluation with proper radiologic consultation. Alternatively, when a mass is determined to be solid, urologic consultation and surgical evaluation are necessary. Minimization of the imaging sequence and hospitalization are critical in the diagnostic-related group era. Aimless wandering in the quagmire of imaging techniques is very expensive and nonproductive. Proper selection of one or two imaging tools and occasionally needle puncture should produce clarification of the cystic or solid nature of renal mass. On the basis of our experience, we have designed an imaging algorithm that provides a simple and concise approach to the diagnosis of a renal mass. It differs in design from that previously suggested by us and others because of decreased emphasis on nuclear medicine and greater emphasis on computed tomography. The more pivotal position assumed by computed tomography is based on improved scanner design and several large series attesting to the accuracy and cost-effectiveness of this imaging technique. It behooves internists to appreciate the role of various imaging tools in evaluating a renal mass. With radiologic consultation, internists should strive to confidently establish the cystic nature of a renal mass and to refer to a urologist solid masses or those whose nature remains persistently equivocal.
D000792:Angiography; D001706:Biopsy; D003365:Costs and Cost Analysis; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D052177:Kidney Diseases, Cystic / Q000175:diagnosis; D007680:Kidney Neoplasms / Q000175:diagnosis*; D009682:Magnetic Resonance Spectroscopy; D011866:Radioisotope Renography; D014056:Tomography, X-Ray; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014567:Urography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging