Incidental renal TSTCs (too small to characterize lesions) and hypodensities are a common occurrence. The ACR gave detailed guidelines on their management in 2017, which can be accessed in this open access article here. These include managing incidentalomas detected on a non-contrast CT, single phase CECT, both non-contrast and contrast CT, and for cystic or fat-containing renal lesions. For example, did you know till how long should you follow-up a Bosniak 2F lesion (upto 5 years is what ACR recommends) or that fat containing lesions which also demonstrate calcifications should be considered RCCs? Read the flowcharts below to know more!

 

1. Managing an incidental renal finding on a single-phase contrast CT

 

2. Managing an incidental renal finding on a non-contrast CT

 

3. Managing an incidental cystic renal lesion

 

4. Managing a solid renal mass or a TSTC on a non-contrast plus contrast CT/MRI

 

5. Managing an incidental renal lesion containing fat

 

– Akshay Baheti, Tata Memorial Hospital

PS: All images are a copyright of the original published article.