DOI: 10.1148/rg.265065701
CT and MR Imaging of Complications of Partial Nephrectomy1
Gary M. Israel, MD,
Elizabeth Hecht, MD and
Morton A. Bosniak, MD
1 From the Department of Radiology, Yale University School of Medicine, PO Box 208042, 333 Cedar St, New Haven, CT 06520-8042 (G.M.I., E.H.); and Department of Radiology, New York University Medical Center, New York, NY (E.H., M.A.B.). Received January 4, 2006; revision requested March 13 and received March 28; accepted March 29. All authors have no financial relationships to disclose.
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Figure 1. Typical postoperative findings in a 48-year-old man after a laparoscopic right partial nephrectomy. Axial contrast-enhanced CT image shows a posterior location of the right kidney, which abuts the posterior abdominal wall. Mild reactive changes (arrows) adjacent to the psoas muscle and liver also can be seen. These are common findings after partial nephrectomy.
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Figure 2a. Postoperative findings in a 62-year-old woman who underwent a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid and well-marginated left renal mass in the lateral aspect of the kidney. (b) Coronal T2-weighted MR image obtained 6 months after surgery demonstrates a wedge-shaped postoperative defect (arrows) in the lateral aspect of the kidney. At the apex of the defect, a small focal area of hypointense signal characteristic of postoperative scar tissue is visible.
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Figure 2b. Postoperative findings in a 62-year-old woman who underwent a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid and well-marginated left renal mass in the lateral aspect of the kidney. (b) Coronal T2-weighted MR image obtained 6 months after surgery demonstrates a wedge-shaped postoperative defect (arrows) in the lateral aspect of the kidney. At the apex of the defect, a small focal area of hypointense signal characteristic of postoperative scar tissue is visible.
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Figure 3a. Fat-filled postoperative defect at MR imaging in a 58-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative sagittal gadolinium-enhanced T1-weighted fat-suppressed image shows a small mass (arrow) in the posterior aspect of the kidney. (b) Axial T1-weighted image, obtained 5 months after surgery, demonstrates a round fat-containing mass (arrow) in the postoperative bed. If a history of surgery were not provided, the mass might be mistaken for an angiomyolipoma. (c) Sagittal gadolinium-enhanced T1-weighted fat-suppressed image, obtained at the same time as b, shows an area of low signal intensity consistent with fat surgically packed into a wedge-shaped postoperative defect. This finding corresponds to the apparently round mass in b. Extensive postoperative reactive changes (arrows) in the retroperitoneum also are visible.
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Figure 3b. Fat-filled postoperative defect at MR imaging in a 58-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative sagittal gadolinium-enhanced T1-weighted fat-suppressed image shows a small mass (arrow) in the posterior aspect of the kidney. (b) Axial T1-weighted image, obtained 5 months after surgery, demonstrates a round fat-containing mass (arrow) in the postoperative bed. If a history of surgery were not provided, the mass might be mistaken for an angiomyolipoma. (c) Sagittal gadolinium-enhanced T1-weighted fat-suppressed image, obtained at the same time as b, shows an area of low signal intensity consistent with fat surgically packed into a wedge-shaped postoperative defect. This finding corresponds to the apparently round mass in b. Extensive postoperative reactive changes (arrows) in the retroperitoneum also are visible.
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Figure 3c. Fat-filled postoperative defect at MR imaging in a 58-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative sagittal gadolinium-enhanced T1-weighted fat-suppressed image shows a small mass (arrow) in the posterior aspect of the kidney. (b) Axial T1-weighted image, obtained 5 months after surgery, demonstrates a round fat-containing mass (arrow) in the postoperative bed. If a history of surgery were not provided, the mass might be mistaken for an angiomyolipoma. (c) Sagittal gadolinium-enhanced T1-weighted fat-suppressed image, obtained at the same time as b, shows an area of low signal intensity consistent with fat surgically packed into a wedge-shaped postoperative defect. This finding corresponds to the apparently round mass in b. Extensive postoperative reactive changes (arrows) in the retroperitoneum also are visible.
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Figure 4a. Fat-filled postoperative defect at CT in a 45-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced image demonstrates a 3-cm-diameter solid mass in the left kidney. (b) Axial contrast-enhanced image, obtained 6 months after surgery, depicts an area of fatty tissue within a wedge-shaped defect at the postoperative site in the left kidney. This finding was due to fat packing at surgery. The posterior location of the left kidney, adjacent to the posterior abdominal wall, is typical of previous renal surgery.
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Figure 4b. Fat-filled postoperative defect at CT in a 45-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced image demonstrates a 3-cm-diameter solid mass in the left kidney. (b) Axial contrast-enhanced image, obtained 6 months after surgery, depicts an area of fatty tissue within a wedge-shaped defect at the postoperative site in the left kidney. This finding was due to fat packing at surgery. The posterior location of the left kidney, adjacent to the posterior abdominal wall, is typical of previous renal surgery.
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Figure 5a. Bioabsorbable hemostatic material at CT in a 53-year-old woman who presented with fever after an open right partial nephrectomy. The fever developed within the 1st week after surgery but was subsequently determined to be due to pneumonia. (a) Preoperative axial contrast-enhanced image demonstrates a solid mass in the anterior portion of the upper pole of the right kidney, a finding that represents a renal cell carcinoma. (b) Axial unenhanced image, obtained 1 week after surgery, demonstrates small bubbles of air, some of which are in linear configurations, in the postoperative bed. Considerable perirenal reactive changes also are depicted, but no fluid collection is seen. The findings are consistent with air pockets within a bioabsorbable agent that was used to control intraoperative bleeding. Images obtained at a follow-up CT examination (not shown) 6 months after surgery showed residual postoperative changes and total resorption of the air bubbles.
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Figure 5b. Bioabsorbable hemostatic material at CT in a 53-year-old woman who presented with fever after an open right partial nephrectomy. The fever developed within the 1st week after surgery but was subsequently determined to be due to pneumonia. (a) Preoperative axial contrast-enhanced image demonstrates a solid mass in the anterior portion of the upper pole of the right kidney, a finding that represents a renal cell carcinoma. (b) Axial unenhanced image, obtained 1 week after surgery, demonstrates small bubbles of air, some of which are in linear configurations, in the postoperative bed. Considerable perirenal reactive changes also are depicted, but no fluid collection is seen. The findings are consistent with air pockets within a bioabsorbable agent that was used to control intraoperative bleeding. Images obtained at a follow-up CT examination (not shown) 6 months after surgery showed residual postoperative changes and total resorption of the air bubbles.
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Figure 6a. Renal atrophy in a 76-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a, b) Preoperative coronal T2-weighted MR image (a) and axial gadolinium-enhanced T1-weighted fat-suppressed MR image (b) demonstrate a complex cystic mass that extends to the renal sinus in a left kidney 9 cm long. Nodular enhancement is visible along the septa (arrows in b). (c) Coronal T2-weighted MR image, obtained 5 months after surgery, depicts atrophy of the left kidney (large arrow), which is now only 6 cm long, and a small fluid collection (small arrow) in the postoperative bed. (d) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image shows an avascular, atrophic left kidney (short arrows) and a small high-signal-intensity fluid collection (long arrow) that likely represents residual blood in the postoperative bed. It was assumed that the left renal artery was injured during surgery and became thrombosed, with resultant left renal infarction.
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Figure 6b. Renal atrophy in a 76-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a, b) Preoperative coronal T2-weighted MR image (a) and axial gadolinium-enhanced T1-weighted fat-suppressed MR image (b) demonstrate a complex cystic mass that extends to the renal sinus in a left kidney 9 cm long. Nodular enhancement is visible along the septa (arrows in b). (c) Coronal T2-weighted MR image, obtained 5 months after surgery, depicts atrophy of the left kidney (large arrow), which is now only 6 cm long, and a small fluid collection (small arrow) in the postoperative bed. (d) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image shows an avascular, atrophic left kidney (short arrows) and a small high-signal-intensity fluid collection (long arrow) that likely represents residual blood in the postoperative bed. It was assumed that the left renal artery was injured during surgery and became thrombosed, with resultant left renal infarction.
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Figure 6c. Renal atrophy in a 76-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a, b) Preoperative coronal T2-weighted MR image (a) and axial gadolinium-enhanced T1-weighted fat-suppressed MR image (b) demonstrate a complex cystic mass that extends to the renal sinus in a left kidney 9 cm long. Nodular enhancement is visible along the septa (arrows in b). (c) Coronal T2-weighted MR image, obtained 5 months after surgery, depicts atrophy of the left kidney (large arrow), which is now only 6 cm long, and a small fluid collection (small arrow) in the postoperative bed. (d) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image shows an avascular, atrophic left kidney (short arrows) and a small high-signal-intensity fluid collection (long arrow) that likely represents residual blood in the postoperative bed. It was assumed that the left renal artery was injured during surgery and became thrombosed, with resultant left renal infarction.
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Figure 6d. Renal atrophy in a 76-year-old man after an open left partial nephrectomy for renal cell carcinoma. (a, b) Preoperative coronal T2-weighted MR image (a) and axial gadolinium-enhanced T1-weighted fat-suppressed MR image (b) demonstrate a complex cystic mass that extends to the renal sinus in a left kidney 9 cm long. Nodular enhancement is visible along the septa (arrows in b). (c) Coronal T2-weighted MR image, obtained 5 months after surgery, depicts atrophy of the left kidney (large arrow), which is now only 6 cm long, and a small fluid collection (small arrow) in the postoperative bed. (d) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image shows an avascular, atrophic left kidney (short arrows) and a small high-signal-intensity fluid collection (long arrow) that likely represents residual blood in the postoperative bed. It was assumed that the left renal artery was injured during surgery and became thrombosed, with resultant left renal infarction.
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Figure 7a. Hematoma in a 41-year-old man who presented with hematuria 4 days after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid enhanced mass (arrow) in the posterolateral aspect of the left kidney. (b) Axial contrast-enhanced CT image, obtained 4 days after surgery, depicts a homogeneous mass (arrow) with attenuation of 55 HU, a finding consistent with a hematoma. The mass extends from the postoperative bed to the perinephric space and subcutaneous tissues of the flank. When unenhanced images (not shown) were compared with contrast-enhanced images, no enhancement was seen in the postoperative bed on the contrast-enhanced images. This finding helped to confirm the diagnosis of hematoma and to exclude residual neoplasm and active bleeding.
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Figure 7b. Hematoma in a 41-year-old man who presented with hematuria 4 days after an open left partial nephrectomy for renal cell carcinoma. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid enhanced mass (arrow) in the posterolateral aspect of the left kidney. (b) Axial contrast-enhanced CT image, obtained 4 days after surgery, depicts a homogeneous mass (arrow) with attenuation of 55 HU, a finding consistent with a hematoma. The mass extends from the postoperative bed to the perinephric space and subcutaneous tissues of the flank. When unenhanced images (not shown) were compared with contrast-enhanced images, no enhancement was seen in the postoperative bed on the contrast-enhanced images. This finding helped to confirm the diagnosis of hematoma and to exclude residual neoplasm and active bleeding.
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Figure 8a. Pseudoaneurysm in a 63-year-old woman after a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative coronal T2-weighted MR image demonstrates a predominantly low-signal-intensity mass (arrow) at the lower pole of the left kidney. The mass appeared solid and enhanced at gadolinium-enhanced MR imaging. (b) Coronal oblique maximum intensity projection image obtained with MR angiography 3 weeks after surgery shows a 3-cm-diameter well-defined collection of contrast material (arrows) in the postoperative bed at the lower pole of the left kidney. The signal intensity in the collection is similar to that in the aorta, a finding consistent with a pseudoaneurysm of a lower polar branch of the left renal artery. (c) Conventional selective angiogram of the left renal artery depicts the pseudoaneurysm (arrows). (d) Conventional selective angiogram of the left renal artery, obtained after embolization, shows complete thrombosis of the pseudoaneurysm.
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Figure 8b. Pseudoaneurysm in a 63-year-old woman after a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative coronal T2-weighted MR image demonstrates a predominantly low-signal-intensity mass (arrow) at the lower pole of the left kidney. The mass appeared solid and enhanced at gadolinium-enhanced MR imaging. (b) Coronal oblique maximum intensity projection image obtained with MR angiography 3 weeks after surgery shows a 3-cm-diameter well-defined collection of contrast material (arrows) in the postoperative bed at the lower pole of the left kidney. The signal intensity in the collection is similar to that in the aorta, a finding consistent with a pseudoaneurysm of a lower polar branch of the left renal artery. (c) Conventional selective angiogram of the left renal artery depicts the pseudoaneurysm (arrows). (d) Conventional selective angiogram of the left renal artery, obtained after embolization, shows complete thrombosis of the pseudoaneurysm.
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Figure 8c. Pseudoaneurysm in a 63-year-old woman after a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative coronal T2-weighted MR image demonstrates a predominantly low-signal-intensity mass (arrow) at the lower pole of the left kidney. The mass appeared solid and enhanced at gadolinium-enhanced MR imaging. (b) Coronal oblique maximum intensity projection image obtained with MR angiography 3 weeks after surgery shows a 3-cm-diameter well-defined collection of contrast material (arrows) in the postoperative bed at the lower pole of the left kidney. The signal intensity in the collection is similar to that in the aorta, a finding consistent with a pseudoaneurysm of a lower polar branch of the left renal artery. (c) Conventional selective angiogram of the left renal artery depicts the pseudoaneurysm (arrows). (d) Conventional selective angiogram of the left renal artery, obtained after embolization, shows complete thrombosis of the pseudoaneurysm.
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Figure 8d. Pseudoaneurysm in a 63-year-old woman after a laparoscopic left partial nephrectomy for renal cell carcinoma. (a) Preoperative coronal T2-weighted MR image demonstrates a predominantly low-signal-intensity mass (arrow) at the lower pole of the left kidney. The mass appeared solid and enhanced at gadolinium-enhanced MR imaging. (b) Coronal oblique maximum intensity projection image obtained with MR angiography 3 weeks after surgery shows a 3-cm-diameter well-defined collection of contrast material (arrows) in the postoperative bed at the lower pole of the left kidney. The signal intensity in the collection is similar to that in the aorta, a finding consistent with a pseudoaneurysm of a lower polar branch of the left renal artery. (c) Conventional selective angiogram of the left renal artery depicts the pseudoaneurysm (arrows). (d) Conventional selective angiogram of the left renal artery, obtained after embolization, shows complete thrombosis of the pseudoaneurysm.
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Figure 9a. Urinary leak at the incision site in a 68-year-old man after an open left partial nephrectomy. (a) Preop-erative axial contrast-enhanced CT image demonstrates a solid enhanced mass (arrow), which was surgically proved to be a renal cell carcinoma, in the left kidney. (b) Axial contrast-enhanced CT image obtained during the nephrographic phase of enhancement, 5 days after surgery, demonstrates a postoperative defect in the renal parenchyma (long arrow) that contains fluid (urine) and that extends into the perirenal space. Mild dilatation of the proximal ureter (short arrow), which contains a small amount of air, likely is due to recent surgery. (c) Axial contrast-enhanced CT image obtained during the excretory phase of the examination shows an accumulation of contrast material in the perinephric space, a finding that established the presence of a urinary leak. Leakage ceased after placement of a ureteral stent.
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Figure 9b. Urinary leak at the incision site in a 68-year-old man after an open left partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid enhanced mass (arrow), which was surgically proved to be a renal cell carcinoma, in the left kidney. (b) Axial contrast-enhanced CT image obtained during the nephrographic phase of enhancement, 5 days after surgery, demonstrates a postoperative defect in the renal parenchyma (long arrow) that contains fluid (urine) and that extends into the perirenal space. Mild dilatation of the proximal ureter (short arrow), which contains a small amount of air, likely is due to recent surgery. (c) Axial contrast-enhanced CT image obtained during the excretory phase of the examination shows an accumulation of contrast material in the perinephric space, a finding that established the presence of a urinary leak. Leakage ceased after placement of a ureteral stent.
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Figure 9c. Urinary leak at the incision site in a 68-year-old man after an open left partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a solid enhanced mass (arrow), which was surgically proved to be a renal cell carcinoma, in the left kidney. (b) Axial contrast-enhanced CT image obtained during the nephro-graphic phase of enhancement, 5 days after surgery, demonstrates a postoperative defect in the renal parenchyma (long arrow) that contains fluid (urine) and that extends into the perirenal space. Mild dilatation of the proximal ureter (short arrow), which contains a small amount of air, likely is due to recent surgery. (c) Axial contrast-enhanced CT image obtained during the excretory phase of the examination shows an accumulation of contrast material in the perinephric space, a finding that established the presence of a urinary leak. Leakage ceased after placement of a ureteral stent.
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Figure 10a. Urinoma in a 56-year-old man 1 year after an open left partial nephrectomy. (a) Coronal reformatted CT image shows a fluid collection (arrows) superior to the left kidney, at the partial nephrectomy site. (b) Axial contrast-enhanced CT image obtained during the nephrographic phase of enhancement depicts a fluid collection in the left renal fossa, as well as several surgical clips (arrows). (c) Axial contrast-enhanced CT image, obtained 45 minutes after the injection of contrast material, shows higher overall attenuation in the fluid collection and a fluid-contrast level (arrow) indicative of a communication with the collecting system. These features are diagnostic of a urinoma.
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Figure 10b. Urinoma in a 56-year-old man 1 year after an open left partial nephrectomy. (a) Coronal reformatted CT image shows a fluid collection (arrows) superior to the left kidney, at the partial nephrectomy site. (b) Axial contrast-enhanced CT image obtained during the nephrographic phase of enhancement depicts a fluid collection in the left renal fossa, as well as several surgical clips (arrows). (c) Axial contrast-enhanced CT image, obtained 45 minutes after the injection of contrast material, shows higher overall attenuation in the fluid collection and a fluid-contrast level (arrow) indicative of a communication with the collecting system. These features are diagnostic of a urinoma.
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Figure 10c. Urinoma in a 56-year-old man 1 year after an open left partial nephrectomy. (a) Coronal reformatted CT image shows a fluid collection (arrows) superior to the left kidney, at the partial nephrectomy site. (b) Axial contrast-enhanced CT image obtained during the nephrographic phase of enhancement depicts a fluid collection in the left renal fossa, as well as several surgical clips (arrows). (c) Axial contrast-enhanced CT image, obtained 45 minutes after the injection of contrast material, shows higher overall attenuation in the fluid collection and a fluid-contrast level (arrow) indicative of a communication with the collecting system. These features are diagnostic of a urinoma.
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Figure 11a. Recurrent neoplasm in a 65-year-old man after a laparoscopic left partial nephrectomy. (a) Preoperative axial gadolinium-enhanced T1-weighted fat-suppressed MR image demonstrates a 2-cm-diameter solid heterogeneously enhanced mass in the left kidney. Pathologic analysis of the surgical specimen revealed a renal cell carcinoma with surgical margins free of tumor cells. (b) Axial contrast-enhanced CT image, obtained 11 months after surgery, reveals a 2.2-cm-diameter solid enhanced mass (small arrow) at the postoperative site in the lateral aspect of the left kidney, a finding consistent with a recurrent neoplasm, as well as a tumor implant (large arrow) in the perinephric space. The patient subsequently underwent a radical nephrectomy, at which the imaging findings were confirmed.
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Figure 11b. Recurrent neoplasm in a 65-year-old man after a laparoscopic left partial nephrectomy. (a) Preoperative axial gadolinium-enhanced T1-weighted fat-suppressed MR image demonstrates a 2-cm-diameter solid heterogeneously enhanced mass in the left kidney. Pathologic analysis of the surgical specimen revealed a renal cell carcinoma with surgical margins free of tumor cells. (b) Axial contrast-enhanced CT image, obtained 11 months after surgery, reveals a 2.2-cm-diameter solid enhanced mass (small arrow) at the postoperative site in the lateral aspect of the left kidney, a finding consistent with a recurrent neoplasm, as well as a tumor implant (large arrow) in the perinephric space. The patient subsequently underwent a radical nephrectomy, at which the imaging findings were confirmed.
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Figure 12a. Misidentification of a lesion in a 62-year-old woman after a laparoscopic partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a 1-cm-diameter solid enhanced mass (arrow) that protrudes from the posterior aspect of the left kidney. (b) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, obtained a few months after surgery, depicts a renal mass (arrow), apparently the same lesion as in a, in the posterior aspect of the left kidney. (c) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, at a level 2 cm below that in b, demonstrates postoperative changes (arrow) in the lateral aspect of the left kidney. (d) Preoperative CT scan, evaluated retrospectively, shows a nonspecific minimal bump (arrow) in the same location as the postoperative changes in c. The bump is believed to have been mistaken for the 1-cm-diameter lesion and resected at laparoscopic surgery. Pathologic analysis of the surgical specimen showed that it was a benign fibroma. The patient decided against further surgery and is undergoing regular follow-up examinations.
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Figure 12b. Misidentification of a lesion in a 62-year-old woman after a laparoscopic partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a 1-cm-diameter solid enhanced mass (arrow) that protrudes from the posterior aspect of the left kidney. (b) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, obtained a few months after surgery, depicts a renal mass (arrow), apparently the same lesion as in a, in the posterior aspect of the left kidney. (c) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, at a level 2 cm below that in b, demonstrates postoperative changes (arrow) in the lateral aspect of the left kidney. (d) Preoperative CT scan, evaluated retrospectively, shows a nonspecific minimal bump (arrow) in the same location as the postoperative changes in c. The bump is believed to have been mistaken for the 1-cm-diameter lesion and resected at laparoscopic surgery. Pathologic analysis of the surgical specimen showed that it was a benign fibroma. The patient decided against further surgery and is undergoing regular follow-up examinations.
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Figure 12c. Misidentification of a lesion in a 62-year-old woman after a laparoscopic partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a 1-cm-diameter solid enhanced mass (arrow) that protrudes from the posterior aspect of the left kidney. (b) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, obtained a few months after surgery, depicts a renal mass (arrow), apparently the same lesion as in a, in the posterior aspect of the left kidney. (c) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, at a level 2 cm below that in b, demonstrates postoperative changes (arrow) in the lateral aspect of the left kidney. (d) Preoperative CT scan, evaluated retrospectively, shows a nonspecific minimal bump (arrow) in the same location as the postoperative changes in c. The bump is believed to have been mistaken for the 1-cm-diameter lesion and resected at laparoscopic surgery. Pathologic analysis of the surgical specimen showed that it was a benign fibroma. The patient decided against further surgery and is undergoing regular follow-up examinations.
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Figure 12d. Misidentification of a lesion in a 62-year-old woman after a laparoscopic partial nephrectomy. (a) Preoperative axial contrast-enhanced CT image demonstrates a 1-cm-diameter solid enhanced mass (arrow) that protrudes from the posterior aspect of the left kidney. (b) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, obtained a few months after surgery, depicts a renal mass (arrow), apparently the same lesion as in a, in the posterior aspect of the left kidney. (c) Axial gadolinium-enhanced T1-weighted fat-suppressed MR image, at a level 2 cm below that in b, demonstrates postoperative changes (arrow) in the lateral aspect of the left kidney. (d) Preoperative CT scan, evaluated retrospectively, shows a nonspecific minimal bump (arrow) in the same location as the postoperative changes in c. The bump is believed to have been mistaken for the 1-cm-diameter lesion and resected at laparoscopic surgery. Pathologic analysis of the surgical specimen showed that it was a benign fibroma. The patient decided against further surgery and is undergoing regular follow-up examinations.
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Figure 13a. Abscess in a 64-year-old man after an open left partial nephrectomy. (a) Preoperative axial gadolinium-enhanced fat-suppressed MR image shows a solid enhanced mass that abuts a calyx of the left kidney. The mass proved to be an oncocytoma. (b) Axial contrast-enhanced CT image, obtained 3 weeks after surgery, depicts a fluid and gas collection, which has a thickened wall, in the left perinephric space just inferior to the surgical bed. This finding was consistent with a postoperative abscess. The abscess was drained percutaneously.
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Figure 13b. Abscess in a 64-year-old man after an open left partial nephrectomy. (a) Preoperative axial gadolinium-enhanced fat-suppressed MR image shows a solid enhanced mass that abuts a calyx of the left kidney. The mass proved to be an oncocytoma. (b) Axial contrast-enhanced CT image, obtained 3 weeks after surgery, depicts a fluid and gas collection, which has a thickened wall, in the left perinephric space just inferior to the surgical bed. This finding was consistent with a postoperative abscess. The abscess was drained percutaneously.
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Figure 14a. Laceration of the liver and pyelonephritis in a 45-year-old woman after a laparoscopic right partial nephrectomy. (a) Preoperative coronal multiplanar reformatted CT image demonstrates a renal neoplasm at the lower pole of the right kidney, in close proximity to the liver. (b) Axial contrast-enhanced CT image, obtained 5 days after surgery because of fever and flank pain, depicts a heterogeneous right nephrogram with multiple areas of decreased attenuation (arrows). In conjunction with the symptoms of fever and flank pain, these findings are consistent with pyelonephritis, although small areas of infarction might have a similar CT appearance. (c) Axial contrast-enhanced CT image obtained during the same examination, at a level inferior to that in b, shows a laceration of the inferior right lobe of the liver and a small hematoma. The laceration is presumably secondary to inadvertent trauma to the liver at the time of surgery. The low-attenuation regions in the kidney are consistent with pyelonephritis.
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Figure 14b. Laceration of the liver and pyelonephritis in a 45-year-old woman after a laparoscopic right partial nephrectomy. (a) Preoperative coronal multiplanar reformatted CT image demonstrates a renal neoplasm at the lower pole of the right kidney, in close proximity to the liver. (b) Axial contrast-enhanced CT image, obtained 5 days after surgery because of fever and flank pain, depicts a heterogeneous right nephrogram with multiple areas of decreased attenuation (arrows). In conjunction with the symptoms of fever and flank pain, these findings are consistent with pyelonephritis, although small areas of infarction might have a similar CT appearance. (c) Axial contrast-enhanced CT image obtained during the same examination, at a level inferior to that in b, shows a laceration of the inferior right lobe of the liver and a small hematoma. The laceration is presumably secondary to inadvertent trauma to the liver at the time of surgery. The low-attenuation regions in the kidney are consistent with pyelonephritis.
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Figure 14c. Laceration of the liver and pyelonephritis in a 45-year-old woman after a laparoscopic right partial nephrectomy. (a) Preoperative coronal multiplanar reformatted CT image demonstrates a renal neoplasm at the lower pole of the right kidney, in close proximity to the liver. (b) Axial contrast-enhanced CT image, obtained 5 days after surgery because of fever and flank pain, depicts a heterogeneous right nephrogram with multiple areas of decreased attenuation (arrows). In conjunction with the symptoms of fever and flank pain, these findings are consistent with pyelonephritis, although small areas of infarction might have a similar CT appearance. (c) Axial contrast-enhanced CT image obtained during the same examination, at a level inferior to that in b, shows a laceration of the inferior right lobe of the liver and a small hematoma. The laceration is presumably secondary to inadvertent trauma to the liver at the time of surgery. The low-attenuation regions in the kidney are consistent with pyelonephritis.
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Figure 15. Right flank hernia in a 63-year-old man 1 year after an open right partial nephrectomy. Gadolinium-enhanced T1-weighted fat-suppressed MR image demonstrates a right flank hernia (arrow), secondary to the surgical procedure, that contains part of the colon. The right kidney is posteriorly located in the retroperitoneum. Atrophy of the kidneys, of unknown cause, is present.
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Copyright © 2006 by the Radiological Society of North America.
