الفهرس 
Anatomy of the kidneyOnly 14 pages are availabe for public view
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Abstract
This work was performed for 40 patients with different renal masses and perirenal collections. The clinical presentations were variable; the most common was loin pain and incidentally discovered renal mass.
The incidence of incidental renal masses is rising due to the widespread use of abdominal cross-sectional imaging. Minimally invasive interventional procedures such as RFA and trans-catheter renal artery embolization of renal masses have become the new standard for the treatment of benign and malignant renal lesions.
Image-guided percutaneous drainage and aspiration is a simple, safe and rapid technique for managing patients with perirenal collections (abscesses, hematomas or urinomas) without need for general anaesthesia as well as patients with symptomatic simple renal cysts. CT guided percutaneous biopsy from renal masses is an important tool to establish a diagnosis before operative nephrectomy or interventional radiologic procedures.
Our study comprised 4 different entities of interventional procedures: RFA of renal masses, trans-catheter arterial embolization of renal masses (RCC & AML), image-guided percutaneous drainage of collections and renal cyst ablation and the last entity was CT guided biopsy from renal masses.
RFA of renal masses under CT guidance is a therapeutic nephron-sparing option in patients refusing or unfit for surgery and those with multiple or heritable RCC. The success rate was 100% according to the short term follow up.
Pre-operative angio-embolization of RCC is useful for the surgeon as it reduces the operative blood loss and induces tissue edema, hence facilitating the tumor dissection and retrieval of the thrombus if present from the renal vein and IVC.
Trans-arterial embolization of AML is not only used during rupture, it can also be used in elective situation when the tumour is bigger than 4 cm, or when enlarged vessels or aneurysms are identified, which can be the source of bleeding. The successful procedure is hindered to non refilling of the occluded artery and aneurysm if present as well as preservation of the renal parenchyma (no infarction).
Image guided percutaneous drainage of perirenal collections is one of the most common and rewarding interventional procedures. The technical success is immediately apparent by aspiration of contents and is nearly always achieved. This procedure offers an immediate and minimally invasive solution to a life-threatening condition, often resulting in restoration of hemodynamic stability within short period.
Image-guided percutaneous aspiration and sclerotherapy of symptomatic simple renal cysts using 95% ethanol has been reported to be an effective treatment with a very low recurrence rate.
Few minor complications have been reported and were self limited such as: 2 cases with small perinephric hematomas and 3 cases with flank pain as a part of post-embolization syndrome.
In conclusion, interventional radiologic techniques have an effective role in management of renal and perirenal masses with low incidence of complications and lower hospitalization costs with respect to surgical treatment. Our study conducted the following: 1) RFA of renal masses is well-tolerated procedure that has demonstrated acceptable short- to intermediate-term outcomes. 2) Renal artery embolization is an effective therapeutic and adjuvant tool because it facilitates the dissection of large malignant renal tumors as well as sufficient treatment of large or bleeding AML. 3) Imaging-guided percutaneous drainage of perirenal collections plays a crucial role in the management of these collections with high success rate. 4) US-guided renal cyst sclerotherapy is an easy, safe and effective procedure that could be done in outpatient clinic. 5) With the progressive increase in the number of incidentally discovered renal masses, imaging-guided renal biopsies will continue to serve as a useful tool for the evaluation and management of renal diseases.