The diagnosis of renal cell carcinoma was frequently delayed due to the anatomic location of kidneys. Recently, the development of echographic imaging techniques has drastically changed this situation. In this retrospective review of 71 patients with renal cell carcinoma, the diagnosis was made incidentally during a routine abdominal ultrasound examination in 49% of cases. These patients, has lower stage and smaller tumors than symptomatic patients. Among the latter, hematuria was the principal presenting symptom. The early diagnosis of renal cell carcinoma allows more conservative surgical procedures and has a favorable effect on long term survival.