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Hello and welcome to Noon Conferences hosted by MRI Online. Noon Conference

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was created when the pandemic hit as a way to connect the global

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radiology community through free live educational conferences that are accessible

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for all. It has become an amazing weekly opportunity to learn alongside

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radiologists from around the world and we encourage you to ask questions

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and share ideas to help the community learn and grow.

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You can access the recording of today's conference and previous Noon Conferences

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MRI Online premium membership to get access to hundreds of case based micro

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learning courses across all key radiology sub specialties.

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Learn more at mrionline.com. Today we are honored to broadcast this lecture

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from Dr. Edward Lee on the imaging evaluation of pediatric renal masses,

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a practical approach. Dr. Edward Lee is an associate professor of radiology

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at Boston Children's Hospital and Harvard Medical School.

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Since Dr. Lee was appointed as the chief of the retic imaging division

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in 2010 to 2021 and director of MRI from 2012 to 2014.

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He has integrated imaging performance and interpretation across all modalities

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for congenital and acquired pediatric disorders at BCH. Dr. Lee has been

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an author on more than 250 peer reviewed journal articles, 185 review articles

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or book chapters and seven internationally wide use textbooks across pediatric

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imaging. With that being said, we welcome you and I will now share

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the recording of our presentation. Hello everyone. Thank you very much for

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inviting me. My name is Edward Lee from Boston Children's Hospital.

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Today we will be discussing a very practical topic in pediatric imaging,

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which is renal mass imaging evaluation. These are the objectives of my presentation

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today, which include. First, we are going to learn practical imaging approach

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for renal masses in children. And second, we will discuss current imaging

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techniques. And lastly but importantly, we will review characteristic imaging

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appearance of common and selected rare neoplastic renal masses and mimics

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in children. Starting with imaging algorithm, when you encounter children

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with suspected renal masses, often based on physical examination findings,

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including abdominal distension, pain, hematuria, and hypertension, it is

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important to consider relevant clinical information such as underlying syndrome

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or genetic mutation prone to developing renal tumors in children. Radiography

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is often used as the initial imaging modality which is non specific,

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but can be helpful for showing secondary signs of renal masses such as opacity,

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associated mass defect, and calcification, or sometimes alternative diagnosis.

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After radiography, ultrasound is often used to detect renal masses and subsequently

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cross sectional imaging studies such as CT or MRI for confirmation of diagnosis,

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further characterization, preoperative assessment for surgical lesions,

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and follow up evaluation. Okay, first let's start with radiography.

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Which one of these three radiographs that you have here may have an

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underlying renal mass? I'm going to give you a little time for you

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to think. I think that everyone did very well. Yes, the first one

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on your left side. There is an opacity in the left side of

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the abdomen with bowel loops displaced to the right side.

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Because of that, there's probably the left sided renal mass. The one in

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the middle has centralization of bowel loops in the setting of ascites.

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The last one on your right side shows bowel loops displaced superiorly and

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bilaterally, which was due to a large mass in the mid abdomen and

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pelvis. Let's move on to some statistics regarding renal masses in children.

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These are the six most commonly encountered renal neoplasms in children

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including first Wilms tumor, next renal cell carcinoma, clear cell sarcoma,

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Rhabdoid tumor, mesoblastic nephroma, and lymphoma. The topics of renal

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masses that we'll discuss today include first, primary benign and malignant

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renal neoplasms, secondary neoplasm or metastatic disease, and mimics of

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renal masses in children. And we're going to start with benign renal neoplasms

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in children which include mesoblastic nephroma, ossifying renal tumor of

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infancy, angiomyolipoma, and multilocular cystic nephroma. Mesoblastic nephroma

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is the most common solid renal tumor in the neonate which occurs during

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the first three months of life and accounting for approximately 5%

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of all renal tumors in children. It is also known as a fetal renal hematoma.

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A typical clinical presentation includes palpable abdominal mass, hypercalcemia,

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congestive heart failure, and hypertension. On pathology, cellular type

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is the most common type. On imaging, you will see a large solid intravenous

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mass with well circumscribed border. A cystic area represents either necrosis

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or underlying hemorrhage. Associated calcification is rare, and usually

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contrast enhancement is a lesser degree than adjacent normal renal tissue.

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Mesoblastic nephroma has an excellent prognosis with nephrectomy with complete

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surgical margin. Chemotherapy is only needed if surgical resection is incomplete

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and tumor ruptures during surgery. What about ossifying renal tumor of infancy?

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It is a rare benign renal neoplasm in infants with characteristic imaging

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findings. A clinically affected infant typically presents with abdominal

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mass and gross hematuria. On imaging, characteristic intravenous sub tissue

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mass without substantial contrast enhancement is seen. Central calcification...