Renal hemangioblastoma (RH) is a rare benign renal neoplasm that may mimic clear cell renal cell carcinoma (ccRCC) before surgery. Published contrast-enhanced ultrasound (CEUS) descriptions of RH remain limited. We report a pathology-confirmed case to describe its CEUS appearance in correlation with contrast-enhanced CT (CECT) and pathologic findings. A 27-year-old asymptomatic woman was incidentally found to have a 3.6-cm solid mass in the lower pole of the left kidney. Ultrasound showed a well-circumscribed, predominantly isoechoic mass with internal heterogeneity and marked vascularity. CEUS showed early heterogeneous hyperenhancement with a peripheral hyperenhancing rim and scattered nonenhancing foci; mild washout became apparent by 46 s, but the lesion remained relatively hyperenhancing overall at 180 s without definite late washout. CT showed a hypervascular mass with marked heterogeneous corticomedullary enhancement and later attenuation decline. Magnetic Resonance Imaging (MRI) was not performed. Because malignancy could not be confidently excluded, partial nephrectomy was performed. Histopathology examination showed a capillary-rich stromal tumor with diffuse inhibin-α and S100 expression. Despite focal PAX8/PAX2 and CAIX/CD10 expression overlapping with ccRCC, the integrated morphologic and immunophenotypic findings supported the diagnosis of RH. No recurrence was detected on ultrasound during 6 months of follow-up. Sporadic RH should be included in the differential diagnosis of a small hypervascular renal mass that mimics ccRCC. In this case, relative hyperenhancement persisting at 180 s on CEUS may represent a nonspecific descriptive clue, but definitive diagnosis still requires integrated pathologic interpretation.
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