Renal venous infarct
Presentation:
Patient referred to the ultrasound department with history of non specific right lower quadrant abdominal pain.
Patient Data:
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Ultrasound demonstrates a heterogeneous mass at the upper pole of the kidney. Grey scale and doppler examination demonstrates a thrombus extending into the IVC.
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C+ portal venous phase
CECT image of the hypodense area at the upper pole of RK
CT demonstrates a wedge of poorly / non-enhancing renal parenchyma at the upper pole, and non-enhancing thrombus extending into the renal vein.
Case Discussion:
This is an unusual case. On grey scale imaging the patient was found to have a heterogenous, predominantly hyperechoic mass at the upper pole of the right kidney with associated thrombus in the segmental vein. The thrombus was seen extending into the right renal vein and also into the IVC. A provisional diagnosis of possibility of neoplasia (renal cell carcinoma) with renal vein thrombus was given.
The patient further underwent a contrast enhanced CT and a PET scan which revealed a focal, upper pole venous infarct of the right kidney with associated thrombus in the draining vein. No enhancement of either the parenchymal lesion or the thrombus was evident to suggest an underlying neoplasm.
On further questioning, the patient only had a history of progesterone intake for last 20 days. No other contributory history or symptoms of hematuria/albuminuria was present.
Segmental renal venous infarction in an otherwise healthy patient is very unusual and hardly described condition.
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