Malignant Inferior Vena Cava Leiomyosarcoma
Savio George Barreto, Shailesh V. Shrikhande in Dilemmas in Abdominal Surgery, 2020
The findings were discussed at the sarcoma multidisciplinary team meeting, following which the patient proceeded to surgery. She underwent a laparotomy via a midline incision along with a resection of the mass including the inferior vena cava, the right kidney, and the right colon, en bloc (Figure 44.2). The inferior vena cava and left renal vein were ligated, leaving renal venous drainage via a lumbar collateral. A saline filled spacer was inserted at the time of surgery to facilitate postoperative radiotherapy, however this was removed two weeks postoperatively due to infection and radiotherapy was never administered. She eventually made a good recovery from the surgery, maintained good renal function, and improved lower limb circulation. She remained disease free until two years postoperatively, when she developed a left lung metastasis, proven on core biopsy. Metastatectomy was considered but unfortunately not feasible, so she has been referred for palliative chemotherapy.
Urinary system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
MRI provides transverse, sagittal and coronal views. The use of IV gadolinium-containing contrast is also possible should it be required for solid structures such as the kidneys. Enhancement features are different for each organ and are influenced by the period of time between contrast administration and image acquisition. Protocols will vary between imaging departments; in general, kidneys are scanned using T2-weighted and T1-weighted images before gadolinium-containing contrast is administered. This is followed by dynamic post-contrast T1-weighted images. Fluids appear hyper-intense on T2-weighted images and coronal T2-weighted images provide excellent visualisation of the entire length of the ureters and the bladder. T1-weighted pre- and post-contrast sequences are valuable to depict and characterise kidney abnormalities. MRI is a cornerstone of evaluation and staging of pelvic malignancies, including prostate and bladder cancer. It gives the best assessment of local staging of the tumour and infiltration of surrounding tissues (‘T’ stage), as well as local lymph node status (‘N’ stage). It may be combined with CT, which is better suited to detection of upper tract disease or complications, and distant metastatic spread (‘M’ stage). MRI is also the gold standard for assessing renal vein thrombosis along with renal venography and CT. MRI can be used in the assessment of suspected renal cell carcinoma, where CT and ultrasound are non-diagnostic or where radiographic contrast is contraindicated. In patients with suspected renovascular hypertension magnetic resonance angiography (MRA) is playing an increasing role and is tending to supplant renal angiography as the primary investigation. MRA is dedicated to evaluating the calibre and the anatomy of the vessels and is particularly useful when there is suspected renal artery stenosis. The technique for MRA is described in Chapter 9. Functional MRU is a newer technique that offers physiological information apart from anatomy. This includes renal blood flow and glomerular filtration rate (GFR). In patients with moderate to severe renal disease, particularly those requiring dialysis, the administration of gadolinium during MRI has been linked to an often severe and potentially irreversible disease called nephrogenic systemic fibrosis [2]. Radiologists must be aware of this condition and restrict gadolinium use in this patient group to situations where the diagnostic information cannot be obtained by other means, and after consultation with clinicians and a full assessment of the risks. Plain radiograph of the abdomen: although not commonly performed in patients with suspected renal disease, a plain radiograph can be carried out to demonstrate opacities in the kidneys, ureters and bladder and is routinely performed prior to IV urography. Plain radiography is also useful among patients presenting with nephrolithiasis.
Current recommendations for the prevention of deep venous thrombosis
Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki in Handbook of Venous and Lymphatic Disorders, 2017
Thrombosis is a major source of morbidity in patients with nephrotic syndrome. Renal vein thrombosis is the most common site of venous thrombosis, occurring in approximately 35% of patients with nephrotic syndrome. Thrombosis in other venous segments can be seen in 20% of cases. Urinary excretion of antithrombin, platelet hyper-reactivity, and elevated plasma viscosity are listed as pathophysiological mechanisms of thrombosis in these patients. In general, renal vein thrombosis occurs as a consequence of underlying disease or cancer of the kidney.
Abdominal Aortic Aneurysm Rupture into a Retro-Aortic Left Renal Vein
Published in Acta Chirurgica Belgica, 2014
B. Balduyck, F. Van Den Brande, R. Rutsaert
We present a case of an abdominal aortic aneurysm ruptured into a retroaortic left renal vein. The patient presented with left flank pain, left-sided varicocoele and haematuria. Imaging showed a juxtarenal AAA associated with a retroaortic left renal vein and simultaneous contrast captation of the aneurysm, the vena cava, the left renal vein and the left vena testicularis. After opening of the aneurysm sac, the defect was controlled by digital pressure and closed by suture. The patient underwent a successful abdominal aorto bi-iliac replacement. We discuss prevalence, clinical features and treatment options of this rare condition.
Leiomyoma of the Left Renal Vein A Report of a Case
Published in Acta Chirurgica Belgica, 2009
M. Zelic, M. Uravic, N. Petrosic, R. Dobrila-Dintinjana, N. Ivanis, D. Kovac, D. Miletic
Only a few cases of leiomyoma of the vena cava or iliac vein and, according to our knowledge, only one case of renal vein leiomyoma have been reported. We report a patient with leiomyoma of the left renal vein. Tumour resection was performed by resecting a part of the vein along with the tumour and by ligation of the vein. Left kidney drainage was established through the preserved ovarian vein. In order to establish a diagnosis, careful pathologic examination of multiple sections has to be done and because of the potentially malignant behaviour, long-term follow-up after total resection is necessary.
The forgotten urinalysis: an integral part of unmasking thrombophilia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Marvi Qureshi, Fortune Alabi, Francis Christian, Claudia Romero
A 43-year-old female presented with flank pain of two days duration. She had been admitted previously for bilateral lower extremity edema which had not improved with diuresis. Abdominal Imaging showed left ovarian vein thrombosis and left renal vein thrombosis extending into the IVC. Chest imaging revealed right lower lobe segmental pulmonary emboli. Careful review of serial urinalysis during previous admissions revealed significant proteinuria. Confirmatory urine tests followed by a renal biopsy led to a diagnosis of membranous nephropathy. We report a case of acute diffuse thromboembolism due to membranous nephropathy, unmasked by serial abnormal urinalysis.
Related Knowledge Centers
- Inferior Vena Cava
- Suprarenal Vein
- Vein
- Veins
- Kidney
- Capillary Beds
- Inferior Phrenic Veins