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Renal peripelvic lymphangiectasia after bilateral renal vein thrombosis
  1. Nicolas Villard1,
  2. Jean-Yves Meuwly1,
  3. Marc Righini2,
  4. Nicolas Alberti3 and
  5. Céline Habre4
  1. 1Service de radiodiagnostic et radiologie interventionnelle, Département de radiologie médicale, Lausanne University Hospital (CHUV), Lausanne, Switzerland
  2. 2Service d'angiologie et d'hémostase, Départment de médecine, University Hospitals (HUG), Geneva, Switzerland
  3. 3Groupe d'expertise en imagerie abdominale, TMF, Bordeaux, France
  4. 4Service de radiologie, Département diagnostique, Geneva University Hospitals (HUG), Geneva, Switzerland
  1. Correspondence to Dr Nicolas Villard; nicolas.villard{at}chuv.ch

Abstract

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.

  • Radiology
  • Interventional radiology
  • Renal medicine
  • Immunology

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Footnotes

  • Contributors The authorship statement signed by all five authors is uploaded (step 2: online supplemental material). CH was the radiologist in charge of the patient. She analysed the images and wrote the reports. MR was the angiologist responsible of the patient during his treatment and follow-up. NV designed the case report and elaborated the physiopathological hypothesis. NA reviewed the data and, as expert in genitourinary imaging, validated the diagnosis. J-YM and NA supervised the findings of this work. All authors discussed the results and contributed to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.