Case 354 Medical history 2 years old male patient presented red urine 4 months ago and recurrence 2 months ago, according to his mother. Urine analysis revealed multiple red blood cells per field, with 4% dysmorphic erythrocytes and proteinuria. Abdominal ultrasound showed increased right kidney with preserved contour and morphology, and presence of nodular formation of slightly increased echogenicity on its superior third, measuring 4,7 x 3,7 cm. Upper abdomen MRI was then requested. Image 1: Magnetic resonance imaging (MRI) of the upper abdomen, coronal reconstruction, T2-weighted, without contrast administration. Image 2: Magnetic resonance imaging (MRI) of the upper abdomen, axial views at the kidneys level, T1-weighted, before (A and B) and after (C and D) intravenous contrast administration. Question Considering the clinical data and the images, the most likely diagnosis is: Neuroblastoma Renal cell carcinoma Wilms Tumor Simple renal cyst. Test question (Medical Residence – UNB - ADAPTED) 3 year-old patient, previously healthy and asymptomatic, comes to routine general paediatrics consultation which identified a mass on the right lateral portion of the abdomen. Mother revealed that the patient’s urine has recently become red. Patient was, then, referred to specialized centre for diagnostic approach.Question Based on the clinical data provided, considering costs, accessibility, celerity, adverse effects and information provided, which is the most adequate approach to be requested as the first-line investigation for a neoplastic hypothesis: Abdomen radiography Abdominal ultrasound Abdominal MRI Positron-emission tomography Time is Up! Time's up
