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1.
Medicine (Baltimore) ; 102(2): e32509, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36637926

RESUMO

RATIONALE: Renal nutcracker syndrome is a rare phenomenon that often causes various disability symptoms. The treatment protocol has been explored for a long time, but no consensus has been reached. PATIENT CONCERNS: Here, we report the case of a 19-year-old male suffering with nutcracker syndrome, including left-sided flank pain and intermittent gross hematuria. DIAGNOSES: The patient was diagnosed with renal nutcracker syndrome, and the pressure gradient between the left renal vein and inferior vena cava was >5 mm Hg. INTERVENTIONS: The patient underwentrobotic-assisted combined transposition of left renal vein and gonadal vein. OUTCOMES: Flank pain and gross hematuria ceased spontaneously after surgery without occurrence. LESSONS: Robotic-assisted combined transposition of the left renal vein and gonadal vein is a safe and promising option for this condition.


Assuntos
Síndrome do Quebra-Nozes , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Adulto Jovem , Adulto , Veias Renais/cirurgia , Hematúria/etiologia , Hematúria/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/cirurgia , Dor no Flanco/etiologia
2.
Medicine (Baltimore) ; 101(48): e32121, 2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36482645

RESUMO

INTRODUCTION: Renal vein thrombosis (RVT) is a rare clinical entity wherein a blood clot forms in one of the major renal veins or its tributaries. Patients with certain risk factors, such as adults with nephrotic syndrome and infants with dehydration, are susceptible to developing it. PATIENT CONCERNS: We present a young woman with primary thrombosis in the right renal vein and inferior vena cava. Hormonal therapy and the reception of the Medigen Vaccine Biologics Corporation coronavirus disease 2019 vaccine were the suspected risk factors for developing this disease. PRIMARY DIAGNOSIS, INTERVENTIONS, OUTCOMES: The primary thrombosis in the right renal vein and inferior vena cava was diagnosed using abdominal computed tomography (CT), and 90% of the thrombus in the right renal vein was dissolved after ultrasound-assisted catheter-directed thrombolysis followed by urokinase infusion for 1 week. Antibiotics and rivaroxaban were prescribed for 3 days and 5 months, respectively. Cryoprecipitate transfusions based on the level of fibrinogen were also prescribed. No long-term complications were noted in the clinic visits. We demonstrate the results of ultrasound-assisted catheter-directed thrombolysis using urokinase infusion for thrombosis in the right renal vein and inferior vena cava. Lastly, we review the literature discussing RVT relevant to this case. CONCLUSION: This study reveals the successful use of the novel technique, ultrasound-assisted catheter-directed thrombolysis using urokinase infusion, for the treatment of RVT.


Assuntos
COVID-19 , Trombose , Humanos , Veias Renais/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Vacinas contra COVID-19 , COVID-19/complicações
3.
Acta Clin Croat ; 61(1): 138-144, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36398079

RESUMO

Three-dimensional printed polyetheretherketone (PEEK) extravascular stent was applied to treat a 14-year-old boy with nutcracker syndrome. Digital subtraction angiography revealed a segment of the left renal vein (LRV) with reduced contrast filling immediately before its inflow into the inferior vena cava, and high-pressure gradient. The three-dimensional reconstruction model demonstrated that the LRV and the duodenum were contracted at the aortomesenteric angle, resulting in LRV compression from the abnormal high-level duodenal compartment. When duodenum courses between the abdominal aorta and superior mesenteric artery (duodenal interposition), the LRV entrapment occurs even at <90 aortomesenteric degrees. Three-dimensional printed PEEK extravascular stent was chosen to elevate the superior mesenteric artery and lower the duodenum position, thus relieving LRV compression. This extravascular application has significant advantages over open surgery, endovascular stenting and artificial vessel procedures with expanded polytetrafluoroethylene. It provides better cellular vitality by ensuring soft tissue proliferation. By reducing external acceleration and centrifugal force, a three-dimensional printed PEEK extravascular stent reduces adverse side effects. Such a stent has a distinctive personalized design, good stiffness, and durability that allows blood vessel growth, preventing stent migration and thrombosis. Therefore, it is suitable for both adult and pediatric patients. According to the abdominal ultrasound and multi-slice computed tomography scan, the postoperative follow-up results were satisfactory one year after surgery. The patient felt well, the blood flow in the LRV was not obstructed, and the blood flow velocity was average. The external stent was in place.


Assuntos
Síndrome do Quebra-Nozes , Adulto , Masculino , Humanos , Adolescente , Criança , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/cirurgia , Stents/efeitos adversos , Veias Renais/cirurgia , Cetonas , Polietilenoglicóis , Impressão Tridimensional
5.
Medicine (Baltimore) ; 101(38): e30653, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197208

RESUMO

RATIONALE: Perivascular epithelioid cell tumor (PEComa) is a mesenchymal tumor that arises from perivascular epithelioid cells and can differentiate into melanocytes and smooth muscle cells. Malignant renal perivascular epithelioid cell tumor is extremely rare. Due to the lack of specific clinical manifestations and imaging features, diagnosing PEComa depends on postoperative pathology and immunohistochemistry. Surgery is the primary treatment for malignant PEComa because the efficacy of radiotherapy and chemotherapy is uncertain. There is still a lack of unified diagnostic criteria and treatment guidelines for renal malignant PEComa, especially with vascular invasion. Hence, the treatment experience depends on a small number of cases reported worldwide. PATIENT CONCERNS: A 68-year-old woman was admitted to our hospital due to intermittent hematuria for over 8 months. The color Doppler ultrasound and computed tomography scan revealed a mass in the lower middle part of the left kidney. DIAGNOSIS: Rare renal malignant perivascular epithelioid cell tumor with renal vein cancerous thrombosis. INTERVENTIONS: A laparoscopic radical left nephroureterectomy in the oblique supine lithotomy position was performed. OUTCOMES: The operation process went smoothly, and no pulmonary embolism occurred after the operation. The final pathological diagnosis was a renal malignant perivascular epithelioid cell tumor. After a 12-month follow-up, no recurrence or metastasis was found. LESSONS: Renal malignant PEComa is an extremely rare mesenchymal tumor diagnosed mainly based on pathology. Surgery is currently the effective treatment for malignant PEComa. For the surgical treatment of malignant renal PEComa with vascular invasion, laparoscopic radical nephroureterectomy in the oblique supine lithotomy integrative position has many benefits, as exemplified by our current case.


Assuntos
Nefropatias , Laparoscopia , Tumores Neuroendócrinos , Neoplasias de Células Epitelioides Perivasculares , Sarcoma , Trombose , Idoso , Feminino , Humanos , Rim/patologia , Nefropatias/cirurgia , Nefroureterectomia , Tumores Neuroendócrinos/cirurgia , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/patologia , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Veias Renais/patologia , Sarcoma/cirurgia , Trombose/cirurgia
7.
Ren Fail ; 44(1): 1519-1527, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36069515

RESUMO

OBJECTIVES: The aims of the study were to identify whether left renal vein (LRV) entrapment was more prevalent in IgA nephropathy (IgAN) and Henoch-Schönlein purpura nephritis (HSPN) compared with other types of renal diseases, and the association of LRV entrapment with glomerular incidental IgA and galactose-deficient-IgA1 (Gd-IgA1) deposition. METHODS: A total of 797 patients with biopsy-proven kidney diseases have been screened for LRV entrapment by color Doppler ultrasound, and the prevalence of LRV entrapment in different types of renal diseases were then analyzed. Propensity score matching analysis was used to adjust for age, gender, and body mass index. Immunostaining of Gd-IgA1 with KM55 was performed in paraffin-embedded sections of renal biopsy specimens. RESULTS: LRV entrapment was diagnosed in 47 patients (6%) with several kinds of renal diseases in our cohort. A total of 32 (68%) LRV entrapments were combined with expanded IgAN (idiopathic IgAN and HSPN). The prevalence of LRV entrapment in expanded IgAN was significantly higher than that in non-expanded IgAN (17 vs. 2%, p < 0.001), even after adjustment for age, gender, and body mass index by propensity score matching analysis (13 vs. 2%, p < 0.001). Removing expanded IgAN and LN, glomerular incidental IgA deposition was observed to be significantly more common in patients with LRV entrapment compared with patients without it (43 vs. 9%, p < 0.001). Furthermore, in glomerular diseases with incidental IgA deposits, significantly much larger proportion of patients with LRV entrapment were positive for glomerular Gd-IgA1 in contrast to patients without LRV entrapment (5/5 vs. 5/17, p = 0.01). CONCLUSIONS: LRV entrapment coexisted with several kinds of renal diseases, with a significantly higher prevalence in patients with idiopathic IgAN and HSPN. In patients of LN and IgAN-unrelated disease with LRV entrapment, glomerular IgA and Gd-IgA1 deposition was more common compared with patients without LRV entrapment.


Assuntos
Glomerulonefrite por IGA , Glomerulonefrite , Vasculite por IgA , Nefrite , Glomerulonefrite/complicações , Glomerulonefrite por IGA/complicações , Glomerulonefrite por IGA/patologia , Humanos , Vasculite por IgA/complicações , Imunoglobulina A , Veias Renais/patologia
8.
J Hypertens ; 40(10): 2076-2080, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36052528

RESUMO

Renal arteriovenous fistula (RAVF) is a rare vascular disease and is usually presented with severe hypertension. Renin-angiotensin-aldosterone system (RAAS) activation was proposed to play a key role in RAVF-induced hypertension but the data was inconsistent. We reported a case of RAVF presented as malignant hypertension, which was detected by contrast-enhanced ultrasonography and successfully managed by interventional embolization. A 35-year-old male was presented with a headache and blurred vision. His blood pressure was up to 220/110 mmHg, with significantly elevated serum creatinine and proteinuria. Hypertensive target organ impairments were noted. A RAVF was detected by contrast-enhanced renal ultrasonography. He underwent renal artery angiography and renal arteriovenous fistula embolization. RAAS activation was also evaluated by separate renal vein sampling. The patient's blood pressure and target-organ damage improved after RAVF embolization and blood pressure control. This is a rare case of renal arteriovenous fistula with malignant hypertension. Contrast-enhanced ultrasonography can be useful for diagnosis.


Assuntos
Fístula Arteriovenosa , Hipertensão Maligna , Hipertensão Renal , Hipertensão , Adulto , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Humanos , Hipertensão/complicações , Hipertensão/patologia , Hipertensão Maligna/complicações , Hipertensão Renal/complicações , Masculino , Artéria Renal/diagnóstico por imagem , Artéria Renal/patologia , Veias Renais/diagnóstico por imagem
9.
J Int Med Res ; 50(9): 3000605221126382, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36168704

RESUMO

Percutaneous nephrostomy is a critical procedure for establishing surgical pathways from the skin to the renal collecting system. The drainage tube involved in the procedure rarely deviates into the renal vein. Herein, we report three cases in which the related drainage tube was mistakenly inserted into the renal vein and inferior vena cava after the renal vein was injured during percutaneous nephrostomy. In the three cases, the nephrostomy tube and double-J tube were gradually withdrawn from the renal pelvis or renal calyces under computed tomography (CT) monitoring. In case 1, the fistula tube was not completely withdrawn in time into the renal, causing multiple thromboses in the vein. The fistula was successfully withdrawn from the vena cava after the filter was placed. Finally, the stones were cleared in two cases and one case was discharged without complications after substantial renal function recovery. A safe and reliable approach is to gradually withdraw, within a short timeframe and under CT monitoring, an ectopic renal vein or inferior vena cava drainage tube into the renal pelvis. Removal of the catheter to the renal pelvis or calyces within 3 days can reduce thrombotic complications.


Assuntos
Nefrostomia Percutânea , Drenagem , Humanos , Pelve Renal , Nefrostomia Percutânea/efeitos adversos , Nefrostomia Percutânea/métodos , Veias Renais/diagnóstico por imagem , Veias Renais/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
11.
Eur J Cardiothorac Surg ; 62(4)2022 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-36069635

RESUMO

The incidence of retroaortic left renal vein (RLRV) is less than 6%. This anatomical variation hinders the exposure and anastomosis of visceral arteries during open thoracoabdominal aneurysm repair. This situation may warrant division and ligation of the RLRV using the conventional retroperitoneal approach. This report describes a modified approach wherein the vein is not divided, thereby improving its surgical exposure.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma da Aorta Torácica , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Humanos , Veias Renais/diagnóstico por imagem , Veias Renais/cirurgia
12.
BMC Nephrol ; 23(1): 310, 2022 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-36085017

RESUMO

BACKGROUND: Performing percutaneous renal biopsy procedures in lupus nephritis (LN) and nephrotic syndrome presents a unique challenge to the nephrologist because of the risk of bleeding from the procedure and the hypercoagulable state in hypoalbuminemia. The management of a patient with venous thrombosis with perinephric hematoma post renal biopsy can be difficult if occurred. CASE PRESENTATION: We are presenting a case of perinephric hematoma following percutaneous renal biopsy in a 23-year-old man with lupus nephritis, nephrotic syndrome, and lower limbs deep vein thrombosis (DVT). The patient developed persistent frank haematuria, flank pain and acute urinary retention post-procedure. We have withheld his oral warfarin three days before the procedure, and no anticoagulation was given subsequently. Initial CT Angiography (CTA) renal showing stable hematoma and no visible evidence of vascular injury. Three weeks later, the patient still has persistent frank haematuria and a repeated CTA renal revealed new bilateral renal vein thrombosis. Considering the high risk of worsening symptomatic venous thrombosis, we gave subcutaneous enoxaparin sodium and restart oral warfarin despite ongoing haematuria. The frank haematuria resolved within two days of anticoagulation with no radiological evidence of worsening of the perinephric hematoma. The follow-up ultrasonography a month later showed resolution of the hematoma and renal vein thrombosis with no adverse effect. CONCLUSION: Our experience, in this case, highlighted the importance of case selection for percutaneous renal biopsy among high-risk patients. Additionally, a prolonged frank haematuria in post-renal biopsy with nephrotic syndrome warranted a reassessment, as a clinical presentation of post-procedure perinephric hematoma and renal vein thrombosis can overlap. We also demonstrated that restarting anticoagulation earlier than four weeks in a patient with renal vein thrombosis and post-renal biopsy perinephric hematoma can be safe in the selective case.


Assuntos
Nefropatias , Nefrite Lúpica , Síndrome Nefrótica , Doenças Ureterais , Trombose Venosa , Adulto , Biópsia/efeitos adversos , Enoxaparina/análogos & derivados , Hemorragia Gastrointestinal , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hematúria/etiologia , Humanos , Nefropatias/complicações , Nefrite Lúpica/complicações , Masculino , Síndrome Nefrótica/complicações , Veias Renais/diagnóstico por imagem , Doenças Ureterais/complicações , Trombose Venosa/complicações , Trombose Venosa/etiologia , Varfarina/efeitos adversos , Adulto Jovem
13.
Anat Histol Embryol ; 51(6): 802-809, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36047693

RESUMO

The canine adrenal glands receive blood from the celiac artery, cranial mesenteric artery, caudal phrenic artery, cranial abdominal artery, phrenicoabdominal trunk, abdominal aorta, renal artery and lumbar artery. These are classified into three types: cranial, middle and caudal adrenal branches. It is also known that the adrenal vein flows into the phrenicoabdominal vein. However, individual differences in the branching pattern of adrenal vessels have not been systematically analysed. We evaluated adrenal vessels in dogs that underwent contrast-enhanced abdominal computed tomography (CT). There were 255 arteries travelling to the adrenal glands in 47 cases, with 1-6 arteries travelling per adrenal gland. The arteries included 67 caudal phrenic arteries, 62 aortic arteries, 60 cranial abdominal arteries, 39 renal arteries, 12 phrenicoabdominal trunks, 8 cranial mesenteric arteries, 6 celiac arteries and 1 lumbar artery. Most of the branches were from the aorta and caudal phrenic artery on the left side, and the cranial abdominal and caudal phrenic artery on the right side. A total of 110 adrenal veins were identified. Inflow into the phrenicoabdominal vein and into the right and left renal veins was observed, and we identified no inflow into other veins. This study demonstrated two points: laterality and individual differences in adrenal blood vessels. When evaluating adrenal blood vessels with abdominal contrast-enhanced CT, it is recommended to take images under general anaesthesia with breath-holding and observe them using multiplanar reconstruction.


Assuntos
Abdome , Artéria Renal , Cães , Animais , Artéria Renal/diagnóstico por imagem , Abdome/diagnóstico por imagem , Aorta Abdominal/diagnóstico por imagem , Veias Renais , Glândulas Suprarrenais/diagnóstico por imagem
14.
Urology ; 169: 250-255, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35987378

RESUMO

OBJECTIVE: To better understand renal nutcracker syndrome (NCS) from a patients' perspective starting at presentation and followed through to diagnosis and management METHODS: This descriptive study was conducted on a national level via a self-selected online survey distributed via river sampling by a post on the Facebook Page 'Renal Nutcracker Syndrome Support Group.' RESULTS: Of the 22 responses collected, 95.5% were female and 91% self-identified as White. 43% experienced symptoms as teenagers and 62% were diagnosed as young adults. Prior to receiving a definitive diagnosis, over half of the respondents were worked up for kidney stones (57%) and ovarian cysts (48%) and saw at least 10-15 providers. Nearly 80% experienced constant pain throughout the day. Pain management included prescription oral pain relievers (38%), prescription patches (29%), and physical therapy (19%). Surgical procedures included nephrectomy with auto transplant (38%), left renal vein transposition (10%), and laparoscopic extravascular stent placement (10%). Respondents had high healthcare utilization for management of NCS. Nearly 30% were unable to work and had filed for disability. CONCLUSION: Awareness of NCS should increase among healthcare providers of all specialties to improve quality of care to those living with NCS. It is crucial to keep NCS within the differential diagnosis in patients presenting with gross hematuria and unusual abdominal and/or flank pain.


Assuntos
Síndrome do Quebra-Nozes , Adulto Jovem , Adolescente , Humanos , Feminino , Masculino , Síndrome do Quebra-Nozes/complicações , Síndrome do Quebra-Nozes/diagnóstico , Síndrome do Quebra-Nozes/terapia , Veias Renais/cirurgia , Dor no Flanco , Hematúria/cirurgia , Nefrectomia
15.
J Vasc Surg Venous Lymphat Disord ; 10(6): 1410-1416, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36007798

RESUMO

OBJECTIVE: Nutcracker syndrome (NCS) is an increasingly recognized venous compressive disease. Although people with NCS can experience debilitating symptoms, making an accurate diagnosis can often be challenging owing to the broad spectrum of clinical presentations and radiologic findings. In the present systematic review, we assessed the most frequent clinical and radiologic criteria used in establishing a diagnosis of NCS and have proposed a comprehensive framework for clinical decision-making. METHODS: We performed a systematic review to identify all observational studies or case series conducted within the previous 10 years that had studied patients with a clinical and radiologic diagnosis of NCS. The extracted data included details related to the study design, participant demographics, presenting clinical features, and radiologic criteria. These details were compared between studies and synthesized to establish a comprehensive diagnostic framework that would be applicable to clinical practice. RESULTS: In the present review, we included 14 studies with a total of 384 patients with NCS. The most common clinical features of NCS were hematuria (69.5%), left flank or abdominal pain (48.4%), pelvic pain (23.1%), and varicocele (15.8%). Computed tomography and ultrasound were the most commonly used imaging modalities, with a threshold for left renal vein stenosis of >80% the most frequently used diagnostic parameter. Eight studies had used venography, with the renocaval pressure gradient the most commonly measured parameter. Two studies had reported using intravascular ultrasound. The findings from our review have shown that a thorough clinical workup of NCS should include critical evaluation of the presenting clinical features and exclusion of alternative diagnoses. All patients should undergo duplex ultrasound with or without the addition of computed tomography or magnetic resonance imaging. Any patient considered for therapeutic intervention should also undergo diagnostic venography with measurement of the renocaval pressure gradient and, if available, intravascular ultrasound with measurement of the left renal vein diameters. CONCLUSIONS: NCS is a challenging condition in terms of the diagnosis and management both. We have proposed a comprehensive diagnostic framework based on the currently available literature to aid in clinical decision-making.


Assuntos
Síndrome do Quebra-Nozes , Doenças Vasculares , Algoritmos , Constrição Patológica , Humanos , Masculino , Síndrome do Quebra-Nozes/diagnóstico por imagem , Síndrome do Quebra-Nozes/terapia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Doenças Vasculares/patologia
16.
Rev Med Suisse ; 18(792): 1566-1569, 2022 Aug 24.
Artigo em Francês | MEDLINE | ID: mdl-36004658

RESUMO

Hematuria is frequently encountered in clinical practice. Its diagnostic spectrum is wide: urinary tract infection, lithiasis, malignant tumor and nephropathy. In the absence of one of these causes, the nutcracker syndrome must be evoked. It results from compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. Knowing how to diagnose it can avoid morbid consequences (chronic renal disease, renal vein thrombosis). In addition to hematuria, its main symptoms are left lumbago, varicoceles, and orthostatic proteinuria. The clinical picture and complementary examinations (ultrasound-doppler, computed tomography angiography, magnetic resonance angiography, and phlebography) generally allow the diagnosis to be made. Treatment varies according to age and severity of symptoms.


L'hématurie est fréquemment rencontrée en pratique clinique. Son spectre diagnostique est large : infection urinaire, lithiase, tumeur maligne et néphropathie. En l'absence de l'une de ces causes, le syndrome du casse-noisette doit être évoqué. Il résulte de la compression de la veine rénale gauche entre l'aorte abdominale et l'artère mésentérique supérieure. Savoir le diagnostiquer permet d'éviter des conséquences morbides (maladie rénale chronique, thrombose veineuse rénale). Outre l'hématurie, ses principaux symptômes sont la lombalgie gauche, les varicocèles et la protéinurie orthostatique. Le tableau clinique et les examens complémentaires (échographie-doppler, angioscanner, angio-IRM et phlébographie) permettent généralement de poser le diagnostic. Le traitement varie en fonction de l'âge et de la sévérité des symptômes.


Assuntos
Hematúria , Veias Renais , Angiografia/efeitos adversos , Hematúria/diagnóstico , Hematúria/etiologia , Humanos , Masculino , Flebografia/efeitos adversos , Flebografia/métodos , Veias Renais/diagnóstico por imagem , Síndrome
17.
Surg Radiol Anat ; 44(8): 1181-1184, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35941238

RESUMO

PURPOSE: Vascular fenestrations are mostly seen in the arterial system and cerebral vessels, but they can be seen rarely in the venous system. In this article, we aimed to present the first case of left renal vein fenestration, which has not been previously reported in the English literature to the best our knowledge. METHODS: Computed tomography angiography (CTA) examination was performed on a 40-year-old male patient who presented with rectal bleeding, and iron deficiency anemia, detected hemorrhoids in colonoscopy, and was planned for superior rectal artery embolization. RESULTS: In CTA examination, a fenestration in the middle part of the left renal vein was detected. The fenestrated segment length was measured approximately 3 cm. The diameter of anterior and posterior channels were 7.66 and 6.01 mm, respectively. The 2.85 mm diameter inferior segmental artery of the left renal artery was passing between the anterior and posterior channels of the fenestrated segment, and there was a slight indentation of this artery to the posterior canal. CONCLUSION: Although venous fenestrations are rare, they can also be seen in the renal venous system, and can be detected with CTA. It is important for radiologists to be aware of this situation, to increase its detectability and to prevent iatrogenic injury in possible surgical procedures. And also as in our case, left renal vein fenestration may be one of the causes of microscopic hematuria.


Assuntos
Aneurisma Intracraniano , Adulto , Artérias , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Veias Renais/diagnóstico por imagem
18.
BMJ Case Rep ; 15(7)2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35858735

RESUMO

Renal peripelvic lymphangiectasia (RPL) is one of the rare conditions that mimic renal cysts. Its physiopathology remains unknown, but an association with renal vein thrombosis has been reported. We share the case of a male patient in his 20s suffering from antiphosphlipid syndrome. The patient was hospitalised for thrombosis of the inferior vena cava (IVC) extending from the iliac veins to the level of renal veins. Consecutive CT and clinical follow-up over the course of 14 years showed the development of numerous retroperitoneal venous collaterals and the apparition of several bilateral peripelvic cystic lesions after extensive thrombosis of the IVC and both renal veins. The renal function remained normal throughout the follow-up. We suggest that the development of RPL is secondary to bilateral renal vein thrombosis. The presumed mechanism would be an increased hydrostatic pressure in the kidney capillaries leading to a more important interstitial fluid drainage by the lymphatic system. To our knowledge, this is the first well-documented case of renal vein thrombosis followed by RPL, contrasting with the previous hypothesis that compression by the lymphangiectasia could cause the thrombosis.


Assuntos
Trombose , Trombose Venosa , Humanos , Veia Ilíaca , Masculino , Veias Renais/diagnóstico por imagem , Trombose/complicações , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/complicações , Trombose Venosa/etiologia
19.
Eur J Pediatr ; 181(9): 3339-3343, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35789292

RESUMO

Nutcracker syndrome related to the left kidney vein compression is a cause of orthostatic proteinuria during childhood. Some studies have shown that the ratios between maximum velocities and anterior-posterior diameters of hilar and aortomesenteric segments of the left kidney vein between upright and supine positions must be more than 4 in order to make a Nutcracker syndrome diagnosis. Our aim was to investigate whether the use of a decrease in aortomesenteric angle between upright and supine positions in the presence of isolated orthostatic proteinuria can be a criterion for the diagnosis of Nutcracker syndrome. Relevant patient information, which included demographic data, clinical examination findings, laboratory data, urinary system ultrasound, and kidney color flow Doppler ultrasound results, were prospectively collected. Thirty-nine pediatric patients with orthostatic proteinuria were included in the study. Left kidney vein compression findings were demonstrated in 31 patients. The ratio of maximum velocities of hilar and aortomesenteric segments of the left kidney vein between upright and supine positions was above 4 in only 7 of our patients. Ratio of aortomesenteric angle between upright and supine positions was significantly decreased for patients with left kidney vein compression findings.  Conclusion: The use of a decrease in the ratio of aortomesenteric angle between upright and supine positions in the presence of orthostatic proteinuria, instead of the ratios for maximum velocities and anterior-posterior diameters of hilar and aortomesenteric segments, can be more helpful for the diagnosis of Nutcracker syndrome in the differential diagnosis of orthostatic proteinuria. What is Known: • Proteinuria may be a sign of an impending kidney disease • Nutcracker syndrome is a cause of orthostatic proteinuria. What is New: • Ratio of aortomesenteric angle between upright and supine positions > 0.6 can be used for Nutcracker syndrome diagnosis.


Assuntos
Síndrome do Quebra-Nozes , Veias Renais , Criança , Humanos , Postura , Proteinúria/diagnóstico , Proteinúria/etiologia , Síndrome do Quebra-Nozes/diagnóstico , Síndrome do Quebra-Nozes/diagnóstico por imagem , Veias Renais/diagnóstico por imagem , Ultrassonografia
20.
J Radiol Case Rep ; 16(5): 17-23, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35711687

RESUMO

Nutcracker syndrome (NCS) is a rare condition caused by the compression of the left renal vein between the abdominal aorta and the superior mesenteric artery. NCS may present with unexplained hematuria. This case report presents a 43-year-old healthy female without any complaints who had newly-detected hematuria in urinalysis during her annual examination. Her physical examination and the whole abdominal ultrasonography failed to explain the cause of hematuria. Further investigation with contrast-enhanced upper abdominal computed tomography revealed a NCS. In unexplained cases of asymptomatic hematuria NCS should be taken into account after excluding other preliminary diagnoses.


Assuntos
Hematúria , Veias Renais , Adulto , Feminino , Hematúria/diagnóstico por imagem , Hematúria/etiologia , Humanos , Artéria Mesentérica Superior , Veias Renais/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios X
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