case_images: PMC6118108_01
case_images: A 65-year-old man with renal cell carcinoma recurrence underwent percutaneous cryoablation. The mass was discovered during follow-up after a prior renal mass cryoablation 3 years ago. Preprocedural noncontrast enhanced axial computed tomography demonstrates an endophytic 5.8 cm x 5.2 cm x 5.5 cm renal mass with a significant involvement of the collecting system and renal sinus.
case_images: JCIS-8-35-g002.jpg
case_images: PMC6118108_01_JCIS-8-35-g002.jpg
case_images: F1
case_images: Nephrometry Score of 10 [Figure 1].
case_images: A 65-year-old man with renal cell carcinoma recurrence underwent percutaneous cryoablation. The mass was discovered during follow-up after a prior renal mass cryoablation 3 years ago. Noncontrast enhanced axial computed tomography showing the cryoneedle arrangement within the target mass and developing iceball formation.
case_images: JCIS-8-35-g003.jpg
case_images: PMC6118108_01_JCIS-8-35-g003.jpg
case_images: F2
case_images: Under general anesthesia, eight 17G cryoneedles (Galil Medical, Yokneam, Israel) were used to completely encompass this endophytic right renal lesion with a surgical margin of 1 cm [Figure 2].
case_images: A 65-year-old man with renal cell carcinoma recurrence underwent percutaneous cryoablation. The mass was discovered during follow-up after a prior renal mass cryoablation 3 years ago. Noncontrast enhanced coronal computed tomography demonstrating the eight cryoneedle arrangement and associated iceball formation see as a spherical hyodensity centered within the renal parenchyma.
case_images: JCIS-8-35-g004.jpg
case_images: PMC6118108_01_JCIS-8-35-g004.jpg
case_images: F3
case_images: Intraprocedural CT was performed using a Siemens Somatom Definition AS 64-MDCT (Siemens AG, Munich, Germany) during the second freeze-thaw cycle and demonstrated adequate ice-ball coverage of 7.3 cm x 6.8 cm x 6.2 cm [Figure 3].
case_images: A 65-year-old man with renal cell carcinoma recurrence underwent percutaneous cryoablation. The mass was discovered during follow-up after a prior renal mass cryoablation 3 years ago. Postprocedural non-contrast enhanced axial computed tomography showing hemorrhage filled and enlarged renal pelvis (*) with adjacent perirenal hemorrhage (arrow).
case_images: JCIS-8-35-g005.jpg
case_images: PMC6118108_01_JCIS-8-35-g005.jpg
case_images: F4
case_images: Postprocedural noncontrast-enhanced CT demonstrated hyperdense material adjacent to the right kidney and within the renal pelvis consistent with blood products [Figure 4]; otherwise, the patient was hemodynamically stable.
case_images: A 65-year-old man with renal cell carcinoma recurrence underwent percutaneous cryoablation. The mass was discovered during follow-up after a prior renal mass cryoablation 3 years ago. Non-contrast enhanced axial computed tomography showing a thunderbolt like iceball fracture along the posterior aspect of the iceball represented by a spherical hypodensity along the posterior aspect of the kidney.
case_images: JCIS-8-35-g006.jpg
case_images: PMC6118108_01_JCIS-8-35-g006.jpg
case_images: F5
case_images: In retrospect, the intraprocedural noncontrast CT performed in the middle of the second freeze-thaw cycle did reveal a lightning bolt or "crack-like" linear hypodensity consistent with ice-ball fracture; however, this finding was overlooked intraprocedurally [Figure 5].