Differential Diagnosis
- Single most likely diagnosis
- Renal cell carcinoma (E): The presence of a 2-cm solid mass in the right kidney, as confirmed by both ultrasonography and MRI, strongly suggests a renal tumor. Renal cell carcinoma is the most common type of kidney cancer in adults, and its incidence increases with age.
- Other Likely diagnoses
- Simple renal cyst (F): Although less likely given the solid nature of the mass, some simple renal cysts can appear solid on imaging due to various factors like hemorrhage or infection. However, the absence of any change in the mass's appearance over time (as might be expected with a cyst) and the patient's age make this less likely.
- Adrenal adenoma (A): While adrenal adenomas are common and can present as incidentalomas, the location of the mass in the kidney rather than the adrenal gland makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Pyelonephritis (D): Although the patient's current presentation does not strongly suggest pyelonephritis (given the absence of fever, flank pain, or costovertebral angle tenderness), any infection in the setting of a renal mass could potentially lead to serious complications, including sepsis.
- Goodpasture syndrome (C): This rare autoimmune disease can cause renal and pulmonary manifestations. While the patient's presentation does not strongly suggest Goodpasture syndrome, missing this diagnosis could have severe consequences due to its potential for rapid progression to renal failure and pulmonary hemorrhage.
- Rare diagnoses
- Glomerulonephritis (B): The patient's normal urine sediment and the presence of a solid renal mass make glomerulonephritis an unlikely diagnosis. Glomerulonephritis typically presents with hematuria, proteinuria, and specific changes in the urine sediment, which are not observed in this case.