History :
This 59 y/o lady began to aware of frequency and dysuria since 2 months ago.

Image finding :
-The left upper calyces is not opacified suspect filling defect at left pelvis R/O tumor or blood clot.
-Abnormal heterogeneous soft tissue mass filling inside the collecting system of left kidney including upper renal calyces and renal pelvis. -There is abnormal enhancement of kidney parenchyma at upper part of left kidney.

Diagnosis :
TCC

Discussion :
Renal TCC

Site:
extrarenal part of renal pelvis > infundibulocaliceal region

IVP:
-single / multiple filling defects in renal pelvis (35%)
-"stipple sign" = contrast material trapped in interstices (DDx: blood clot, fungus ball)
-dilated calyx with filling defect (26%) due to partial / complete obstruction of infundibulum
--"phantom calyx" = failure to opacify from obstruction
--±focal delayed increasingly dense nephrogram
--"oncocalyx" = caliceal distension with tumor
-caliceal amputation (19%)
-absent / decreased excretion with renal atrophy (13%) due to long-standing obstruction of ureteropelvic junction
-hydronephrosis with renal enlargement (6%) due to tumor obstruction of ureteropelvic junction

US:
-bulky hypoechoic (similar to renal parenchyma) mass lesion
-splitting / separation of central renal sinus complex
-infiltrative without bulge of renal contour -focal caliceal dilatation

CT (52% accuracy due to overstaging):
-sessile filling defect in opacified collecting system
-thickening + induration of pelvicaliceal wall
-central solid mass in renal pelvis expanding centrifugally
-compression of renal sinus fat
-invasion of renal parenchyma (infiltrating growth pattern) with preservation of renal contour
-coarse punctate calcific deposits (0.7-6.7%) may mimic urinary calculi -variable enhancement of tumor