case_images: PMC11176450_01
case_images: (A) CT showed a 1.6 cm x 1.4 cm nodule in the left kidney proximal to the renal hilum (white arrow). (B) The arterial phase of the nodule showed marked enhancement (mean 202HU), conspicuously decreased during the (D) venous phase (mean 160HU) and (E) delayed phase (mean 123HU). (C) Enhanced MRI showed significant enhancement of the nidus. (F) T2 displayed the flowing void effect of the nidus.
case_images: fmed-11-1420473-g001.jpg
case_images: PMC11176450_01_fmed-11-1420473-g001.jpg
case_images: fig1
case_images: This nodule showed significant enhancement during the arterial phase (CT value: about 202HU) and conspicuously decreased during the venous phase (CT value: about 160HU), raising the possibility of clear cell renal cell carcinoma (ccRCC; Figure 1).
case_images: 18F-FDG PET/CT images (A, MIP; B, axial fusion PET/CT; C, coronal fusion PET/CT; D, sagittal fusion PET/CT; E, axial PET; F, coronal PET; G, sagittal PET) showed mild FDG uptake in the renal mass (white arrow, SUVmax 4.5). 18F-PSMA-1007 PET/CT images (H, MIP; I-K, axial, coronal, and sagittal fusion PET/CT; L-N, axial, coronal, and sagittal PET) showed no tracer concentration in the left renal lesion (white arrow).
case_images: fmed-11-1420473-g002.jpg
case_images: PMC11176450_01_fmed-11-1420473-g002.jpg
case_images: fig2
case_images: The lesion demonstrated mild FDG uptake with a maximum standard uptake value (SUVmax) of 4.5 (Figure 2). According to the low to moderate uptake of 18F-FDG, the following day, 18F-PSMA-1007 was carried out to evaluate tumor neovascularization. 18F-PSMA-1007 PET/CT scan showed no uptake in the left renal lesion (Figure 2).
case_images: (A) The coronal MIP and (B) volume rending (VR) image displayed the left renal feeding artery (dashed arrows) and thickened draining vein (white arrows). (C) Renal angiography shows the renal aneurysmal sac located in the lower pole of the left renal, which is supplied by a branch of the left renal artery. Early drainage of contrast from the left renal vein is also remarkable. (D) After coil post-embolization, the aneurysmal sac vanished without the renal vein filling up.
case_images: fmed-11-1420473-g003.jpg
case_images: PMC11176450_01_fmed-11-1420473-g003.jpg
case_images: fig3
case_images: CT reconstruction, maximum intensity projection (MIP), and volume rendering (VR) showed feeding arteries and thickened draining veins (Figure 3). Combined with PET/CT, there was no PSMA uptake and near mild FDG uptake, ccRCC can be excluded. After coil post-embolization, the aneurysmal sac vanished without the renal vein filling up (Figure 3).