Presentation
Right flank pain and faintness.
Patient Data
The longitudinal sonographic view demonstrates an intraluminal IVC mass. Power doppler demonstrates incomplete obstruction of the IVC. Further evaluation with contrast-enhanced ultrasound demonstrates vessels within the mass at 46 seconds and enhancement of the mass at 1 minute and 12 seconds.
Longitudinal contrast-enhanced CT image (corticomedullary phase) shows thrombus inside the IVC.
Case Discussion
When a renal mass is found, excluding renal vein and IVC involvement is mandatory and may be performed by means of US, CT and MR. Differentiation between bland or tumor thrombus requires contrast to demonstrate thrombus enhancement. In this case the patient attended our institution with right flank pain due to previously unknown renal tumor with active bleeding, and an emergency US was performed, with CEUS performed on the go to demonstrate thrombus enhancement.