Abstract
Sarcoidosis, known mainly for pulmonary findings, can present with abdominal disease. Abdominal involvement most commonly affects the liver and spleen. Microscopic renal involvement is common but visible disease is unusual. Sarcoidosis of the kidney can cause nephrocalcinosis, nephrolithiasis, lesions or hydronephrosis. 1 Renal sarcoidosis is usually not visible on imaging and rarely presents as noncalcified renal masses. We report on a rare presentation of sarcoidosis with incidental bilateral noncalcified renal masses in the absence of renal dysfunction. CASE REPORT A 40-year-old black woman presented with right back and upper abdominal pain. She had a history of hypertension, cholelithiasis and a recent history of hematuria and urinary tract infection with suspected pyelonephritis. During the evaluation for source of infection, hilar adenopathy was discovered on a chest radiograph. Contrast enhanced abdominal computerized tomography (CT) revealed bilateral, multiple, wedge shaped renal masses from 2.0 to 4.6 cm. (fig. 1). The lesions were homogeneously hypodense and averaged 90 HU compared to adjacent parenchyma, which measured 205 HU. The lesions measured 29 HU on nonenhanced images and were well demarcated. There was no contour deformity of the renal margins. The kidneys were normal in size, and renal vasculature was unremarkable. Additional CT findings were retroperitoneal adenopathy, small hypodense hepatic lesions, gallstones and uterine leiomyomata. Both kidneys appeared normal on abdominal ultrasound for biopsy (fig. 2). No focal renal masses or contour deformities were identified. The cortical echo texture was homogeneous without focal areas of abnormality. After repeat contrast enhanced CT documented the persistence of the renal lesions, biopsy of the right renal lower pole, which had been the most severely affected region on CT, was performed. Pathological evaluation of the samples demonstrated noncaseating granulomas consistent with sarcoidosis. DISCUSSION
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call