Evaluation of Incidental Renal and Adrenal Masses - American Family Physician

www.aafp.org/afp VOLUME 63, NUMBER 2 / JANUARY 15, 2001 these lesions are benign simple cysts that require no further evaluation, intervention or urologic consultation. The primary reason to investigate a renal mass is to exclude a malignant neoplasm. One screening study using ultrasound examinations found clinically or pathologically malignant renal tumors in 12 (0.2 percent) of 5,898 consecutive patients 50 to 79 years of age. The lifetime risk of renal cell carcinoma in a 40-yearold man is 1.34 percent, and the risk of death is slightly greater than 0.5 percent. Renal masses can be broadly categorized into cysts, tumors and inflammatory lesions (Table 1). Although simple cysts are usually asymptomatic, they occasionally cause flank or abdominal pain, a palpable abdominal mass or hematuria. Malignant masses may produce the same symptoms, or they may be associated with paraneoplastic syndromes. Inflammatory lesions are not usually incidental because there is almost always an associated clinical history when symptoms are present. A history of fever, chills or urinary tract infection suggests an infected cyst or an abscess. T he widespread use of abdominal computed tomographic scanning (CT) and ultrasonography has increased the detection of incidental renal and adrenal masses that are found on imaging for problems unrelated to the kidneys or adrenal glands. Based on careful clinical assessment, imaging studies and selected screening laboratory tests, family physicians can diagnose most of these masses and determine the need for referral.