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Incidental renal mass

ACR 2018CT
Flowcharts · click to enlarge
Fat-containing renal mass
Renal mass on non-contrast CT
Renal mass on contrast-enhanced CT

For renal masses found incidentally on CT not performed with a renal mass protocol. Choose the scenario: fat-containing mass, unenhanced CT, or contrast-enhanced CT.

Pearls

  • Homogeneous −10 to 20 HU on any CT, or ≥70 HU on unenhanced CT, is benign enough to stop.
  • 21–69 HU on unenhanced CT and >20 HU on portal venous CT are the two indeterminate attenuation ranges.
  • Once a mass is characterized as cystic with renal mass protocol, use Bosniak 2019.

Sources

  1. Herts BR, Silverman SG, Hindman NM, et al. Management of the incidental renal mass on CT: a white paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2018;15:264–273.PubMed ↗
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Radessential summarizes published classification systems for practicing radiologists. Summaries are condensed; confirm details against the cited source before relying on them for patient care.