This 9-year-old boy enjoyed good health until 1 month before admission, when gross hematuria was noted after accidental trauma. Bloody urine persisted, and the child was admitted to a provincial hospital. Urine and renal examination were normal except for hematuria. Ultrasonography showed a solid, inhomogeneous 4-cm mass in the upper pole of the left kidney. Intravenous urography showed enlargement of the superior pole of the left kidney without distortion of the calyceal system. There was no evidence of periaortic lymphadenopathy or renal vein or inferior vena caval involvement on either imaging study. The child was then admitted to our clinic with suspected Wilms' tumor.
Examination of the abdomen revealed a left flank mass measuring approximately 4 cm in diameter. There were no other important clinical findings. Urinalysis was repeated along with x-ray films and computerized tomography (CT) of the thorax and abdomen and renal ultrasonography . Urinary vanilmandelic acid (VMA) and homovanillic acid (HVA) levels were obtained, and a bone marrow aspiration was performed. These last laboratory tests were all within normal limits.
May we now please review the imaging studies obtained at this point, Dr. Tani?