Doctors Lounge - Urology Answers
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Forum Name: Urology Topics
|Zylaniah - Tue Jun 29, 2010 11:12 am|
My boyfriend went to the ER early May complaining of discomfort in his left back area, and the discomfort was accompanied by nausea, and vomiting.
Upon a CT scan, they found a solid mass on the upper pole of his left kidney about 4.1" by 2.3" His blood pressure was very high as well between 160-170 over 90-105
They sent him home and told him to follow up with a urologist. Being that he is on unemployment, his insurance had ran out, and we do not have money to see one.
Scared, we went to another hospital who admitted him. Upon doing a contrast enhanced CT scan they saw the mass was hemorrhaging so they couldn't say whether it had a neoplastic component to it or not. They stabilized his blood pressure, pumped him full of antibiotics and fluids, and released him with blood pressure medicine.
In the last month and a half, the discomfort has not returned nor the nausea/vomiting, but he has had headaches here and there. Also, no blood in the urine that he can see. He says he feels fine, but we are still scared obviously and want to know best/worst case scenario until we can afford to see a urologist.
Any advice/suggestions would be extremely helpful, and much appreciated.
Quick history: He was diagnosed with a bundle branch block in 2004, other than that he has no health problems. He is a african american 31 year old male, weighs about 270 pounds and stand about 6'1 in height.
No family history of cancer/heart disease/diabetes anything like that to his knowledge.
Thanks so much, and I look forward to your replies.
A concerned girlfriend
|Dr.M.Aroon kamath - Wed Jun 30, 2010 2:23 pm|
Your boyfriend, a young African-American male, apparently has a recently discovered upper pole left renal mass and a chance discovery of hypertension. He apparently was asymptomatic prior to this episode.His electro-cardiogram in 2004 (at the age of approximately 25 yrs) allegedly had shown features of right bundle branch block(RBBB). Why the ECG was performed is unclear.
Hypertension, is a common condition. It is more common among African Americans than among other ethnic groups in the United States.Your boyfriend has what could be termed as "secondary" hypertension.There are a number of causes for this including fibromuscular dysplasia and other stenotic lesions or the renal arteries, pheochromocytomas etc. Bundle branch blocks(right and left) can occur in patients with pheochromocytomas.
Pheochromocytomas occur in people of all races, less frequently in African-Americans.The hypertension in pheochromocytomas may at times be episodic. Mean age at diagnosis is about 40 years. Mean age at diagnosis is approximately 15 years lower in patients with inherited syndromes compared with those with sporadic tumors.Slightly more common in the right adrenal gland.
Renal masses are usually do not of prominently figure in the investigation of hypertension. There is no common correlation between renal masses and hypertension.Very rarely a Pheochromocytoma can be mistaken for an upper pole renal mass. But, this happening is extremely rare nowadays, with the advent of spiral CT & MRI.
If the lesion in your boyfriend's kidney is indeed a renal mass (after excluding the more common causes of secondary hypertension), one should consider the rare renal masses that can cause hypertension.
One such is a juxtaglomerular cell tumor (JCT), a rare, renin-secreting tumor of the kidney which can cause hypertension. JCT is histopathologically benign, and resection of the tumor is curative for hypertension. As in majority of cases, a final accurate diagnosis of this is only possible following surgery, this tumor should be considered & treated as a malignant solid renal mass. Treatment includes radical nephrectomy or partial nephrectomy, depending on the size and location of the tumor.
I hope this information may be useful to you.
|Zylaniah - Wed Jun 30, 2010 2:35 pm|
Thanks for the quick reply. It is much appreciated.
I forgot to mention that he had no hypertension prior to the discovery of this mass on his kidney. He has always been healthy and had no health problems except for the RBBB which doesn't cause him any problems.
Question: Are you saying that the ONLY way to discover what this mass truly is, is to either remove it or would another contrast enhanced CT scan be able to show if it is cancerous or not?
Also, lately he's fatigued more, and having headaches. He also has stated that upon walking for more than a few minutes, he can actually feel something pushing on his left side of the back. Like a pressure. It's never been a pain, more like a discomfort, and only recently saying he can feel something back there.
Thanks again for the quick reply, and I look forward to your response.
|Dr.M.Aroon kamath - Sat Jul 03, 2010 1:01 pm|
Thank you for the update. What i meant was, that in renin-secreting juxtaglomerular cell tumors, a final diagnosis is possible only after the operative specimen is examined histopathologically. For this to happen, one should first confirm that this tumor is indeed secreting renin. If not , it is just another renal incidentaloma and is investigated along those lines.
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