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Upper Urinary Tract Urothelial Cancer
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====== <span style="color:#ff0000">CT urography</span> ====== * High sensitivity (100%) and moderate specificity (60%) for upper tract malignant disease *'''Typical findings suggestive of an upper urinary tract tumor (3):''' *# '''Radiolucent filling defects''' *# '''Non-visualization of the collecting system''' *# '''Obstruction''' * '''<span style="color:#ff0000">Differential diagnosis of filling defect includes (11): [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766367/]</span>''' *# '''<span style="color:#ff0000">Tumour (UTUC, renal cell carcinoma, renal lymphoma, fibroepithelial polyp)</span>''' *# '''<span style="color:#ff0000">Blood clot</span>''' *# '''<span style="color:#ff0000">Suburothelial hemorrhage</span>''' *#'''<span style="color:#ff0000">Stones</span>'''; higher HFU than urothelial carcinoma *# '''<span style="color:#ff0000">Renal papillary necrosos/sloughed papilla</span>''' *# '''<span style="color:#ff0000">Hypertrophied papilla</span>''' *#'''<span style="color:#ff0000">Inflammation</span>''' *#'''<span style="color:#ff0000">Fungus ball</span>''' *# '''<span style="color:#ff0000">Tuberculosis</span>''' *#'''<span style="color:#ff0000">Polyureteritis cystics</span>''' *#'''<span style="color:#ff0000">Retroperitoneal fibrosis</span>''' * '''Urothelial cancers are enhancing on arterial/early nephrographic phase, dark/filling defect in urographic phase.''' *'''Urothelial cancers have more infiltrative features compared to RCC''' *'''Radiolucent, noncalcified lesions may require additional evaluation by retrograde urography or ureteroscopy, with or without biopsy and cytology''' * '''<span style="color:#ff0000">Important to evaluate contralateral kidney to assess (2):''' **'''<span style="color:#ff0000">Possible bilateral disease''' **'''<span style="color:#ff0000">Functionality of the contralateral kidney''' [[File:Renal parenchymal phase CT of transitional cell carcinoma.jpg|CT urogram demonstrating filling defect in left renal pelvis. [[commons:File:Renal_parenchymal_phase_CT_of_transitional_cell_carcinoma.jpg|Source]]|center|frame]]
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