Renal Parenchymal Infections, Cysts, and Renal Neoplasms — WACS Viva & Clinical Scenarios (Genitourinary and Retroperitoneal Imaging)

Exam-style renal parenchymal infections, cysts, and renal neoplasms viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 52-year-old woman with poorly controlled type 2 diabetes mellitus presents with high-grade pyrexia, left flank pain, and acute septic shock. Multiphasic non-contrast and contrast-enhanced abdominal CT images are displayed, demonstrating extensive parenchymal destruction of the left kidney, streaky gas throughout the renal cortex and medulla, gas extending into the anterior pararenal and perinephric spaces, and fluid collections. Candidates are asked to systematically review the CT images, provide a definitive radiological diagnosis, classify the disease using standard staging systems, and ou
• SCENARIO 2: Pre-contrast and post-contrast nephrographic phase CT images of an incidental 4.2 cm left renal cystic mass in an asymptomatic 48-year-old man are presented. The mass demonstrates multiple thickened septa measuring approximately 3 mm with measurable contrast enhancement of 28 Hounsfield Units (HU) from baseline, along with focal peripheral coarse calcifications, but without discrete soft-tissue nodularity. Candidates are instructed to analyze the architectural components, assign the appropriate Bosniak 2019 / classic category, and provide the evidence-based recommendation for clinical and surg
• SCENARIO 3: A 26-year-old male with known sickle cell trait (hemoglobin AS) presents with unprovoked gross hematuria, weight loss, and right loin ache. Contrast-enhanced CT and MRI demonstrate an ill-defined, centrally located, highly infiltrative right renal mass centering on the medulla, caliceal obliteration, regional retroperitoneal lymphadenopathy, and a tumor thrombus in the right renal vein. Candidates must formulate a prioritized differential diagnosis tailored to patient demographics, identify key cross-sectional imaging discriminating features, and outline standard TNM vascular staging criteria.
• SCENARIO 4: Axial non-contrast and multiphasic contrast-enhanced CT scans of an asymptomatic 45-year-old woman with tuberous sclerosis demonstrate bilateral, well-circumscribed, solid cortical renal lesions. The largest lesion in the right kidney measures 5.5 cm and displays attenuation values of -45 HU, with avidly enhancing vascularized soft-tissue components. Candidates must identify the pathognomonic radiological signs, discuss management thresholds regarding aneurysm size and lesion diameter, and differentiate the lesion from fat-poor renal neoplasms and retroperitoneal liposarcoma.
• SCENARIO 5: An abdominal CT urogram is provided for a 42-year-old woman with chronic left loin pain and recurrent proteus bacteriuria. The scout and axial excretory images show a large central staghorn calculus within a non-functioning, globally enlarged left kidney, marked caliceal dilatation lined by inflammatory tissue showing the classic bear paw appearance with low attenuation (ranging from -10 to +15 HU), and extensive inflammatory stranding breaching Gerota fascia. Candidates are required to make the primary diagnosis, differentiate it from clear cell renal carcinoma and renal tuberculosis, and sta