Editing Pediatrics: Renal and Adrenal Oncology (section)

==== Imaging ====
* '''<span style="color:#ff0000">Regional'''
** '''<span style="color:#ff0000">Abdominal ultrasound''' 
***'''<span style="color:#ff0000">For all patients with a suspected renal mass, evaluation should begin with an abdominal ultrasound to confirm a solid renal mass and preliminarily evaluate the contralateral kidney.''' 
****This approach guides subsequent imaging specific to the primary renal tumor
** '''<span style="color:#ff0000">CT or MRI abdomen/pelvis with IV contrast'''
***'''<span style="color:#ff0000">All patients with suspected Wilms tumour should undergo either CT or MRI of the abdomen/pelvis''' with IV contrast
**** '''See [https://radiopaedia.org/articles/wilms-tumour Figures]'''
**** '''MRI avoids radiation but typically requires anesthesia or sedation in young children.'''
**** A precise histologic diagnosis cannot be obtained on the preoperative imaging studies
**** The renal origin of the mass is usually apparent on CT, but it can be mistaken for neuroblastoma.
**** Bilateral or multicentric tumors are more typical of Wilms tumor, but renal lymphoma can manifest in this fashion.
** '''IVC involvement'''
*** Occurs in 4% of Wilms tumor patients
***Doppler ultrasonography is particularly helpful to exclude intracaval tumor extension
*** MRI can reliably identify extension of tumor into the IVC.
*** CT was able to detect all clinically significant IVC tumor extension when compared with ultrasonography
** '''<span style="color:#ff0000">Determination of inoperability must be made at surgical exploration, not based on imaging.'''
* '''<span style="color:#ff0000">Distant metastases'''
** '''<span style="color:#ff0000">Chest CT'''
*** '''Lung is the most common site of distant metastasis'''