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Findings in this case: 1) There is a filling defect present in the LEFT renal vein with dilatation of the LEFT renal vein. 2) There is inhomogeneous enhancement of the LEFT kidney. 3) There is fluid in the anterior pararenal space, LEFT paracolic gutter and to a lesser extent posterior pararenal space. Within the perirenal space, there is patchy increased attenuation and a small amount of fluid as well. 4) The LEFT kidney is also enlarged.
Diagnosis: LEFT renal vein thrombosis.
File:1E
Organ system: 1.0 Cardiovascular System
Organ: E Venous Abnormalities
Etiology and incidence. 1) Renal vein thrombosis in children most commonly occur secondary to dehydration accompanying major illnesses including sepsis. 2) In adults, renal vein thrombosis is most frequently associated with nephritic syndrome. A) Nephrotic syndrome: Caused by a variety of disorders that damage the kidneys in various ways but particularly involves damage to the basement membrane of the glomerulus. Disease processes such as glomerulonephritis and glomerulosclerosis are associated with renal vein thrombosis. Other disorders including post-strep nephritis, lupus, multiple myeloma, amyloidosis, trauma, certain drugs and hypercoagulable states including carcinoma. B) Secondarily, renal vein thrombosis can be seen with thrombus in the gonadal veins and invasion of the renal vein by renal neoplasm.
Diagnosis. 1) Symptoms: A) Nephrotic syndrome include: diffuse edema. Proteinuria of greater than 3.5 g per day, low blood protein levels and elevated cholesterol and triglycerides. B) Patient’s present with mild to moderate or advanced anasarca as adults and as children presentation is secondary to the primary disease process. Additionally there is abdominal pain or flank pain. Urinalysis reveals proteinuria and occasionally hematuria. 2) Imaging: a) CT: Enlargement of the kidney with inhomogeneous enhancement on CECT studies, visualization of the thrombus unenhanced examinations while on nonenhanced examinations the renal vein may be dilated, there may be visualization of thrombus extending into the inferior vena cava as well. B) Ultrasound: Enlarged kidney which can be heterogeneous or hypoechoic. The renal vein may be distended with absent flow or visualization of a thrombus on Doppler. C) The LEFT kidney tends to be more commonly involved than the RIGHT. D) In the chronic phase, collateral vessels around the kidney can be seen. The renal vein itself may be small in size secondary to incomplete recanalization. On CECT, webs or other incomplete recanalization changes can be seen including thickening of the vein wall.
Prognosis/Clinical. 1) Treatment: A) if early, direct arterial thrombolysis via interventional radiology can reopen the occluded vein. Where thromboses or webs are demonstrated, angioplasty and/or stent placement can be performed. B) Ensuring that blood pressure remains normalized is important to help delay and decrease renal damage. C) Anti-coagulation therapy. 2) Prognosis and clinical outcomes vary. Response to treatment and response to the primary disease process are the main determinants. Degree of renal failure associated with the primary process is also indeterminate.
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Intrarenal arterial Doppler sonography in the detection of renal vein thrombosis of the native kidney
Am. J. Roentgenol., Jun 1994; 162: 1367 – 1370.
……Doppler sonography in the detection of renal vein thrombosis of the native kidney JF Platt…helpful in the noninvasive workup of renal vein thrombosis. We used arterial Doppler sonography to evaluate cases of possible acute renal vein thrombosis in native kidneys that had equivocal……
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B Blankenship, JP Earls, and LB Talner
Renal vein thrombosis after vascular pedicle injury[clin conference]
Am. J. Roentgenol., Jun 1997; 168: 1574.
…Renal vein thrombosis after vascular pedicle injury[clin…Center, Seattle 98104-2499, USA. Renal vein thrombosis after vascular pedicle injury[clin…Cases from Harborview Medical Center Renal Vein Thrombosis After Vascular Pedicle Injury Barbara……
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Renal Vein Thrombosis
Author: Igor A Laskowski, MD; Chief Editor: William H Pearce, MD more…
Although renal vein thrombosis (RVT) has numerous etiologies, it occurs most commonly in patients with nephrotic syndrome (ie, >3 g/d protein loss in the urine, hypoalbuminemia, hypercholesterolemia, edema).
http://emedicine.medscape.com/article/460752-overview
Akira Kawashima, Carl M. Sandler, Randy D. Ernst, Eric P. Tamm, Stanford M. Goldman, and Elliot K. Fishman
CT Evaluation of Renovascular Disease
RadioGraphics, Sep 2000; 20: 1321 – 1340.
……complicated by hemorrhage. Acute renal vein thrombosis appears as a clot in a distended…junction (UPJ) obstruction, and renal vein thrombosis. CT Techniques Our current…potential vascular injury. Renal Vein Thrombosis Thrombosis of the renal vein……
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Dae Chul Jung, Seung Hyup Kim, Sung Il Jung, Sung Il Hwang, and Sun Ho Kim
Renal Papillary Necrosis: Review and Comparison of Findings at Multi–Detector Row CT and Intravenous Urography
RadioGraphics, Nov 2006; 26: 1827 – 1836.
……cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive…cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive…cell disease, pyelonephritis, renal vein thrombosis, tuberculosis, and obstructive……
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O Helenon, JM Correas, J Chabriais, JC Boyer, P Melki, and JF Moreau
Renal vascular Doppler imaging: clinical benefits of power mode
RadioGraphics, Nov 1998; 18: 1441 – 1454.
……confidence in the diagnosis of renal vein thrombosis and in the assessment of caval…All patients with suspected renal vein thrombosis or intrarenal vascular disorder…in the diagnosis of primary renal vein thrombosis. In our experience, the uniform……
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HS Saunders, RB Dyer, RY Shifrin, ES Scharling, RE Bechtold, and RJ Zagoria
The CT nephrogram: implications for evaluation of urinary tract disease
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……by renal artery stenosis, renal vein thrombosis, or urinary tract obstruction…by renal artery stenosis, renal vein thrombosis, or urinary tract obstruction…by renal artery stenosis, renal vein thrombosis, or urinary tract obstruction……
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