Imaging Pearls ❯ Kidney ❯ Renal Vein
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- Renal Vein Thrombosis: Causes
- Primary hypercoagulability disorders (e.g., antithrombin III deficiency, protein C or S deficiency, factor V Leiden mutation, prothrombin G20210A mutation)
- Antiphospholipid syndrome
- Postrenal transplant/allograft rejection
- Renal vasculitis
- Sickle cell nephropathy
- Systemic lupus erythematosus (SLE)
- Amyloidosis
- Diabetic nephropathy
- Trauma
- Renal tumors extend into the RV (RCC, TCC) - Renal Vein Thrombosis: Facts
- Renal vein thrombosis (RVT), the presence of thrombus in the major renal veins or its tributaries, is a rare clinical entity.
- Males are affected more commonly than females with no racial predilection.
- Clinical manifestations vary by the rapidity of the venous occlusion.
- The most common etiology is nephrotic syndrome, though can be seen with primary hypercoagulability disorders, malignant renal tumors, infections, trauma, or as a post-renal transplant complication.
- “About 30% of individuals demonstrate more than 1 branch of the right renal vein. In about 6% of individuals, the right adrenal gland vein drains into the right renal vein, which reflects the normal anatomy on the left side. Retroperitoneal veins, such as lumbar veins, drain into the right renal vein in about 3% of individuals.”
Recent Innovations in Renal Vascular Imaging
Arash Bedayat et al
Radiol Clin N Am 58 (2020) 781–796
- Renal Vein Thrombosis: Facts
- may be accompanied in 15–20 % of patients by nephrotic syndrome
- RVT is associated with abdominal surgery, including laparoscopic cholecystectomy, trauma, tumor invasion of the renal vein or invasion by primary retroperitoneal diseases. - “CT is currently the imaging method of choice for diagnosing RVT, as it is non-invasive, is somewhat less expensive than other methods, can be performed quickly, and has a high diagnostic accuracy. CT scans have shown high sensitivity (92 %) and specificity (100 %) in diagnosing these lesions and is therefore recommended as an initial diagnostic tool .”
Renal vein thrombosis mimicking urinary calculus: a dilemma of diagnosis
Yimin Wang et al.
BMC Urol. 2015; 15: 61 - RVT may be diagnosed incorrectly as renal colic or renal cell carcinoma on abdominal ultrasonography. Results in our patients showed that a calcified RVT may mimic a urinary calculus on conventional ultrasonography, abdominal plain film and noncontrast CT. Renal stones may also resemble paragonimus calcified oval, renal artery aneurysms and acute renal infarctions. Thus, awareness of the conditions that could mimic those observed during the generation of a urinary calculus is important, particularly if a percutaneous procedure is considered. Ultrasonography alone is not sufficient to rule out RVT in these patients, suggesting the need for CT angiography in evaluating our patients.
Renal vein thrombosis mimicking urinary calculus: a dilemma of diagnosis
Yimin Wang et al.
BMC Urol. 2015; 15: 61 - Renal Vein Thrombosis
- Renal Vein Thrombosis: Etiologies
- Renal cell carcinoma
- Transitional cell carcinoma
- Extra-renal tumors including adrenal cancer
- Leiomyosarcoma of the renal vein (primary)
- trauma
- “The clinical and radiologic signs associated with RVT vary with the acuity of onset and amount of thrombus within the renal vein. Typical symptoms and signs include flank pain, microscopic hematuria, and deterioration of renal function. The most common causes for RVT are extension of renal tumor, trauma, or a hypercoagulable state as seen in nephrotic syndrome (ie, membranous
glomerulonephritis), systemic lupus erythematosus, or an inherited syndrome. Renal vein thrombus occurs in 20% of patients with nephrotic syndrome .”
Acute Urinary Tract Disorders Goel RH et al. Radiol Clin N Am 53 (2015) 1273–1292 - “RVT is more common on the left, because of the longer course of the left vein. CT imaging findings include filling defect in the renal vein, enlarged kidney with extension of edema into the sinus and perinephric fat, and coarse striations. In contrast to bland thrombus, tumor-related thrombus heterogeneously enhances and distends the vein .”
Acute Urinary Tract Disorders Goel RH et al. Radiol Clin N Am 53 (2015) 1273–1292
- Renal AV Malformations: Facts
- Very rare CT findings
- Usually congenital but may be due to underlying tumor
- May be large (aneurysmal) and solitary or numerous and small (cirsoid type). Cirsoid type more common.
- Usually located in renal sinus
- Usually solitary and right sided
- Presentation may be gross hematuria, hypertension, flank pain and high cardiac output failure - Renal Veins: Pathologies
- Renal vein thrombus
- Rein vein tumor thrombus
- Spontaneous splenorenal shunt
- Nutcracker syndrome
- Renal varix
- AV malformation
- Renal Veins: Pathologies
- Renal vein thrombus
- Rein vein tumor thrombus
- Spontaneous splenorenal shunt
- Nutcracker syndrome
- Renal varix
- AV malformation
- Renal Veins: Facts
- Left renal vein is 3x larger than the right renal vein (7.5 cm vs 2.5 cm)
- Multiple renal veins in up to 30% of patients
- Left renal vein variations include retro-aortic renal vein and circumaortic renal vein
- Left renal vein receives the left adrenal vein, left gonadal vein, and a lumbar vein - Renal Veins: Pathologies
- Renal vein thrombus
- Rein vein tumor thrombus
- Spontaneous splenorenal shunt
- Nutcracker syndrome
- Renal varix
- AV malformation - Renal Vein Thrombus: Etiologies
- Glomerulonephritis
- Collagen vascular disease
- Trauma
- Malignancy
- Dehydration (children)
- Sepsis (children) - Renal Vein Thrombus: CT Findings
- Partial or total thrombus in the renal vein
- More common in left renal vein
- Vein may be distended
- Enlarged kidney
- Delayed or persistent CT nephrogram
- Collaterals around kidney (“cobwebs”) - Renal AV Malformations: Facts
- Very rare CT findings
- Usually congenital but may be due to underlying tumor
- May be large (aneurysmal) and solitary or numerous and small (cirsoid type). Cirsoid type more common.
- Usually located in renal sinus
- Usually solitary and right sided
- Presentation may be gross hematuria, hypertension, flank pain and high cardiac output failure