The above CECT images are from a patient who presented to the ER with a recurrent history of left flank pain. A cursory look shows regions of decreased parenchymal enhancement in the left kidney with inflammatory changes of the left perinephric fat which may favor a diagnosis of pyelonephritis. However, there is subtle retroperitoneal adenopathy (left paraaortic and surrounding the left renal artery). Biopsy revealed primary Ewing's sarcoma of the left kidney.
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