Learning Radiology xray montage

Wilm's Tumor

General Considerations

  • Most common abdominal malignancy of children
  • Both kidneys affected synchronously or metachronously in 5-10%
  • Peak incidence at 2.5-3 years
  • More common in blacks than whites with an approximately equal gender distribution

Clinical Findings

  • Asymptomatic abdominal mass most common
  • Abdominal pain
  • Hematuria
  • Hypertension
  • Urinary tract infection
  • Varicocele
  • Aniridia
  • Hemihypertrophy
  • Beckwith-Wiedemann Syndrome

Imaging Findings

  • Ultrasound is frequently the first study
    • Echogenic mass
  • CT is useful in determining extent, lymph nodes and liver metastases
  • Tumors tend to be large and may cross midline
  • Sharply marginated possibly with compressed normal renal tissue
  • May be partially cystic from necrosis
  • Curvilinear or punctate calcifications
  • Invasion of IVC by tumor
  • Hypervascular tumors
  • On MRI, tumor tends to have decreased signal on T1 and increased on T2

Differential Diagnosis

  • Neuroblastoma
  • Polycystic kidney disease
  • Rhabdomyosarcoma


  • Nephrectomy followed by chemotherapy
  • Postoperative radiation therapy for stage II and IV lesions


  • Impaired renal function following nephrectomy is rare
  • Chemotherapeutic agents may be hepatotoxic
  • Scoliosis following radiation therapy


  • 85-90% survival

wilms tumor

wilms tumor

Wilm's Tumor. Conventional radiograph of abdomen shows a large right upper mass displacing bowel loops into the pelvis and across the midline (blue arrows). Coronal and sagittal reformatted CT demonstrate a large, heterogeneous mass arising from the right kidney (white arrows). A small
sliver of functioning right kidney is seen to enhance (yellow arrow).
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