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| LETTERS TO THE EDITOR |
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| Year : 2019 | Volume
: 56
| Issue : 2 | Page : 185 |
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Renal metastasis of lung cancer mimicking renal infarction
Keisuke Watanabe, Kentaro Yumoto, Takeshi Kaneko
Department of Pulmonology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| Date of Web Publication | 2-May-2019 |
Correspondence Address:
Keisuke Watanabe
Department of Pulmonology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004
Japan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijc.IJC_512_18
How to cite this article:
Watanabe K, Yumoto K, Kaneko T. Renal metastasis of lung cancer mimicking renal infarction. Indian J Cancer 2019;56:185 |
Sir,
Cancer patients have increased risk of arterial thromboembolism,[1] and renal metastasis from non-small cell lung cancer is rare. We report renal metastasis of lung adenocarcinoma, which was difficult to differentiate from renal infarction with single modality.
A 71-year-old man, who had postoperative-recurrent lung adenocarcinoma with multiple bone and lung metastasis, visited emergency room for sudden onset of back pain. Limbus fracture with known metastasis was thought to be the cause of pain. However, enhanced computed tomography (CT) revealed unenhancing lesion in left kidney with cortical rim sign [Figure 1]a; D-dimer was extremely high (27.65 μg/mL). Hence, there was a need to differentiate renal metastasis from renal infarction. Ultrasonographic examination showed avascular mass in left kidney [Figure 1]b, and we diagnosed renal metastasis. After he died of pneumonia, autopsy was performed, and pathological findings confirmed renal metastasis of lung adenocarcinoma. | Figure 1: (a) Enhanced CT showed unenhanced lesion with cortical rim sign in left kidney and (b) ultrasonographic examination showed avascular mass in left kidney
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Cortical rim sign is the characteristic CT finding of renal infarction.[2] But renal metastasis in this case showed this sign, and 32.4% of renal infarction had hypoattenuated area with associated mass effect.[2] Besides, cancer patients have increased risk of arterial thromboembolism,[1] and renal metastasis from non-small cell lung cancer is rarely diagnosed in live patients.[3] Therefore, it was difficult to differentiate renal metastasis from renal infarction with single modality in this case.
In conclusion, it is challenging to diagnose renal metastasis when symptoms and CT findings mimic renal infarction. In such cases, multimodality approach might be helpful to diagnose the condition.
We appreciate Ms. Cathy Endo for English editing.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| » References | |  |
| 1. | Navi BB, Reiner AS, Kamel H, Iadecola C, Okin PM, Elkind MSV, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol 2017;70:926-38.  |
| 2. | Suzer O, Shirkhoda A, Jafri SZ, Madrazo BL, Bis KG, Mastromatteo JF. CT features of renal infarction. Eur J Radiol 2002;44:59-64. |
| 3. | Tomita M, Ayabe T, Chosa E, Nakamura K. Isolated renal metastasis from non-small-cell lung cancer: Report of 2 cases. Case Rep Surg 2015;2015:357481. |
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