• Jing-Jing Zhang, Li-Fei Yang, Yi-Zhen Zhang, and Xiao-Hong Xie.
• Ultrasonic Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhengjiang, China.
• Medicine (Baltimore). 2023 Dec 8; 102 (49): e36381e36381.

RationaleWilms' tumor (WT) is the most common pediatric kidney malignancy and is rarely found in adults. Nonspecific clinical symptoms and imaging features often lead to delayed diagnosis or misdiagnosis of adult WT, resulting in poor clinical outcomes. Ultrasound (US), as an efficient and noninvasive examination method, has been widely used in clinical diagnosis and treatment. Therefore, various US evidence is meaningful to improve understanding of adult WT characteristics in ultrasound.Patient ConcernsA 45-year-old female patient with uremia (regular hemodialysis for 13 years) with painless gross hematuria was diagnosed with a right kidney tumor penetrating to the lung. Preoperatively, B-mode ultrasonography showed an ill-defined hyperechoic mass in the right kidney, which revealed an unclear border, uneven internal echoes, and calcification. Besides, the internal blood flow signal of the tumor was detected. Contrast-enhanced ultrasound (CEUS) showed an uneven hyper-enhancement in the tumor ("fast in and slow out"). Contrast-enhanced computed tomography of the kidney indicated a similar result as the CEUS. Moreover, the chest CT identified multiple pulmonary metastatic nodules.DiagnosesAn ultrasound-guided percutaneous core needle biopsy of the tumor proceeded to make a definite diagnosis of adult WT (epithelial type).InterventionsThe patient was treated with tislelizumab.OutcomesNo progress was found to date.LessonsWe report the first case in which CEUS was performed in an adult WT patient with uremia and multiple pulmonary metastases. The features obtained by the US can help in the diagnosis of adult WT and direct further diagnostic procedures.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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