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case_images: Case 1: Interval development of a left renal mass. (A) CT abdomen pelvis from July 2013 demonstrating stable stone burden compared to the original CT from August 2011 (not shown). (B) CT scan in September 2013 following PCNL, revealing a subcapsular hematoma and heterogeneous density in the left renal pelvis concerning for tumor vs blood clot. PCNL, percutaneous nephrolithotomy.
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case_images: He re-presented 22 months later and repeat noncontrast CT abdomen and pelvis revealed stable appearance of his large left staghorn stone, right kidney stones, and bladder stone (Fig. 1A). A restaging CT abdomen and pelvis demonstrated a pseudoaneurysm of the left kidney, residual renal pelvis tumor, as well as significant bladder wall thickness concerning for tumor (Fig. 1).
case_images: Case 1: CT scan from January 2014 following left nephroureterectomy demonstrating diffuse new hypoattenuating lesions consistent with metastatic disease. There is also peritoneal carcinomatosis, increased lymphadenopathy, and moderate intra-abdominal ascites.
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case_images: A CT of the abdomen and pelvis (3 months following last staging CT) demonstrated increased lymphadenopathy, and new lesions throughout the liver with peritoneal carcinomatosis consistent with metastatic disease (Fig. 2).
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case_images: Case 2: Original preoperative CT scan from June 2015 (A: coronal, B: axial) demonstrating bilateral staghorn calculi and a hyperdensity in the central region of the left kidney (arrows) felt to represent indeterminate, possibly representing hemorrhagic or proteinaceous debris.
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case_images: CT scan of the abdomen demonstrated bilateral staghorn calculi, severe bilateral hydronephrosis, and minimal right renal parenchyma with thinned left sided parenchyma. Compared to prior CT in 2013, there was an additional finding of a new hyperdensity within the left lower pole suggestive of hemorrhagic or proteinaceous debris (Fig. 3).
case_images: Case 2: Flank mass eruption from the skin at the nephrostomy tube site. (A) CT abdomen pelvis performed 1 month following PCNL demonstrating what was felt to be hematoma extending to the skin. Nonspecific para-aortic lymph node enlargement was also noted. (B) One week following CT scan, the patient developed eruption of a mass-like structure from the nephrostomy tube site. Biopsy revealed well-differentiated keratinizing SCC.
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case_images: A CT of the abdomen favored hematoma extending to the skin (Fig. 4A) and also noted nonspecific para-aortic lymph node enlargement. Shortly after, the collection was noted to erupt through her flank, revealing a likely tumor (Fig. 4B).
case_images: Case 2: CT abdomen and pelvis from December 2015 (A: coronal, B: axial) demonstrating marked progression of metastatic disease, including metastatic lesions of the lung, pleura, pancreatic neck, and innumerable lesions in the subcutaneous tissue.
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case_images: A CT of the chest, abdomen, and pelvis with contrast demonstrated metastatic lesions of the lungs, pleura, pancreatic neck, and innumerable metastatic lesions in the subcutaneous tissues (Fig. 5).