Left renal vein thrombus associated with renal tumor

Case contributed by Josué Raúl Mijarez Banda

Presentation

Previously known malignant left renal tumor, classified as renal cell carcinoma by histopathology. Weight loss, lethargy and malaise. In the pre-surgical protocol, a study is requested to rule out extension to the left renal vein.

Patient Data

Age: 60 years
Gender: Female

Axial T2-weighted projection shows a left renal tumor with heterogeneous enhancement in the upper pole, dilated ipsilateral renal vein with absence of flow void in its most proximal portion.

DWI and ADC projections show partial diffusion restriction of the left renal tumor. Renal vein shows no obvious diffusion restriction.

Axial T1-weighted projection with intravenous contrast in late phase shows heterogeneous enhancement of a tumor in the left renal upper pole with a filling defect in ipsilateral renal vein without enhancement.

Case Discussion

A tumor thrombus is defined as a tumor extending into a vessel. Imaging features include the presence of enhancement similar to a tumor of origin, vessel expansion, and diffusion restriction.

On the other hand, bland thrombus generally shows no restricted diffusion or enhancement and its behavior is independent of tumor activity.

In this case, a filling defect is identified in the ipsilateral renal vein without enhancement or restriction to diffusion, which is suggestive of a soft thrombus.

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