0:00

Dr. P back again with our

0:01

3 00:00:02,380 --> 00:00:03,310 5-year-old with Wilms' tumor.

0:03

Now we're going to look at a CT

0:05

and briefly talk about ultrasound.

0:07

You know, the appearance of Wilms'

0:08

tumor at ultrasound is very variable.

0:10

I like ultrasound for initial analysis

0:13

to confirm that a mass is present.

0:15

I might use Doppler to corroborate the patency

0:18

of the renal vein and the integrity of the renal

0:21

artery, especially if hypertension is present.

0:25

But frankly, it doesn't pick up the renal artery.

0:27

The histologic biomarkers as well as some

0:30

of the other modalities like CT and MRI, for

0:33

instance, calcification, 9% of the time, but

0:36

on path and on CT, more like 15% of the time.

0:40

So it's more accurate to use some

0:42

of the higher-end modalities.

0:44

Now, one of the advantages of CT is speed.

0:48

You don't necessarily have to sedate the patient,

0:51

and there's some evidence that sedating infants

0:53

and neonates can have long-lasting effects.

0:57

On the other hand, it does

0:59

deliver ionizing radiation.

1:01

So, it's going to be a judgment call.

1:03

We do see some of the histologic

1:05

features we discussed before.

1:06

Now, that fat signal intensity, sorry,

1:09

that fat density, seen on CT is in the

1:11

renal pelvis, not in the mass itself.

1:14

This tumor contained little to no fat.

1:17

There are a few flecks here and there

1:18

on non-contrast imaging of hyperdensity.

1:21

You be the judge, but there are clearly

1:23

foci of hemorrhage, such as that seen in

1:25

the lateral capsule on non-contrast CT.

1:29

And on the right, we have contrast CT, and look

1:32

at the right renal artery, nice and patent.

1:35

And we can also see the right renal

1:37

vein, which is nice and collapsed.

1:39

That we already established before.

1:42

There's the coronal projection. You know, sometimes

1:44

on CT, you can pick up satellite nodules, you

1:47

can pick up crossing of the midline, which occurs

1:50

more frequently in neuroblastoma, and you may

1:53

pick up hypoattenuating areas of necrosis.

1:56

This patient did have one area of necrosis,

1:58

back here, but also an area of hemorrhage

2:01

along the side, which is hyperdense.

2:03

And some hemorrhage here anteriorly in the front.

2:07

Most of these Wilms tumors are going to

2:09

appear macrolobulated, and they may have these

2:13

satellite nodules that we discussed previously.

2:16

Let's move on then away from CT

2:19

and ultrasound and back to MRI.