Renal
Colic with Unusual Course, Severe Renal Vein Thrombosis:
Case Report and Brief
review
Valery Shaikis², Guy Hidas¹, Leonid Chervinsky ², Yaakov Rozenman¹, Joseph Shental¹
¹Urology Department Ha’Emek Medical Center Afula Israel ,²Radiology Department Ha’Emek Medical Center Afula Israel
Case: A 38- year-old male with a known
history of thalassemia beta minor, complaining of colicky pain in loin in the
left side.During the physical examination some tenderness was
found in the left loin and left upper abdomen. Laboratory tests are normal.
Spiral CT is not demonstrating
renal or ureteric calculus, but findings include renal enlargement with perinephric stranding and renal
vein enlargement with capsular venous
collaterals, thickening of the Gerota fascia.
US is the initial study of choice to
exclude RVT.US is a non- invasive method of imaging. Though its
sensitivity is 85% ,specificity of this method is 56% which is
comparatively low. US demonstrates
right kidney is normal and enlarged left kidney. Left renal vein enlargement within thrombus
extending from the left renal vein into the inferior vena cava. Left main renal vein is
not traceable into IVC on color Doppler
Magnetic Resonance Angiography
Recent observations also suggest that
magnetic resonance angiography (MRA) appears to be a useful and accurate alternative test for the diagnosis of
RVT prior to venography when US findings are equivocal. MRA produces high contrast between flowing blood, vascular walls, and
surrounding tissues. Other advantages include the avoidance of contrast
material, its noninvasiveness, and the ability to image both the arterial
and venous phases.
Presently, renal
venography remains the diagnostic criterion standard. Assessing the venous phase of
renal arteriography also helps in making the diagnosis. However,
both are invasive procedures requiring the use of potentially nephrotoxic contrast agents in patients with existing renal
compromise.
Summary: Renal vein thrombosis (RVT) is a
complication of many renal and medical conditions, nephrotic syndrome is known
as the most frequent cause. In order to prevent
complications such as pulmonary embolism and renal insufficiency early diagnosis of the disease is very
important.At present RVT is diagnosed by means of X-ray examinations mostly
without non-invasive methods.