29 y.o gentleman with underlying epilepsy presented with hematuria.

Description

CT Abdomen and  Pelvis  ( 4 Phase Kidneys ) 

Findings;
Right kidney is normal in size and shape. Bipolar length measures 10.6cm.
There are multiple cortical renal nodules with fat densities ( HU < -40 ) throughout the right renal cortex; predominantly subcentimeter in size. The largest nodule measures 1.5 cm x 1.3 cm. No significant nodule enhancement post contrast.
No hydronephrosis or hydroureter.

The left kidney is enlarged and occupied at its upper, medial and inferior parts by a large heterogenously enhancing hypervascular mass measuring 17cm x 8.5cm x 10.0cm. There are  scattered irregular fatty components within the mass and central hypodense locule ; largest locule measures 3.78cm x 3.6cm which could suggest of central necrosis or hemorrhagic fatty component.
The left pelvicalyceal system appears distorted with mid focal caliectasis. No significant hydronephrosis or hydroureter.
The remaining normally enhanced lower pole left kidney is stretched and displaced laterally with  multiple fatty nodules ( 1-2cm).
There is single left renal artery. The mass appears to  be supplied by the left renal and splenic arteries.

Liver, GB, pancreas, spleen, right adrenal are normal.
Left adrenal is not visible ? infiltrated by the renal mass.
Urinary bladder is well distended with CBD insitu.
No bowel related mass.
No significant abdomino-pelvic node.
No ascites.
Minimal bibasal pleural effusion and consolidation.
No suspicious bone lesion. 

Impression:
Features above could suggest of bilateral renal angiomyolipoma with a predominant left renal mass.
However due to the heterogenous features of the large left hypervascular renal mass with minimal fatty content,  renal cell carcinoma could not be excluded.

Case courtesy of Dr Azril