EURORAD ESR

Case 13886

Nephrotic syndrome with renal vein thrombosis and adrenal haematoma

Author(s)
Tonolini Massimo, MD; Valconi Elena, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 43 year(s)
 
 
  • Figure 1
    Pulmonary and aortic CT-angiography (CTA)
     

    Requested to exclude thromboembolism, CTA showed normal lung volumes without active pleuropulmonary changes (a).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    CTA excluded signs of pulmonary embolism and acute aortic diseases. Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units) enlargement of the left adrenal gland (arrowheads) was noted.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) was detected. Note associated stranding of ipsilateral periadrenal fat (*).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) was detected. Note associated stranding of ipsilateral periadrenal fat (*).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;

    The hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) did not enhance after intravenous contrast. Note associated stranding of ipsilateral periadrenal fat (*).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Ultrasound

    Ultrasound confirmed the ovoid-shaped left adrenal enlargement (caliper), measuring approximately 4x3 cm, with unspecific hypoechoic appearance.

     
    Area of Interest: Adrenals; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 3
    Unenhanced and post-contrast multidetector CT of the abdomen
     

    Five days after admission, repeated CT showed partial regression of periadrenal fat stranding (*); the left adrenal enlargement (arrowheads) showed stable size, slightly more demarcated margins, minimal decrease in...

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Thrombolysis; Special Focus: Embolism / Thrombosis;

    The left adrenal enlargement (arrowheads) showed stable size, slightly more demarcated margins, minimal decrease in attenuation (48-50 HU), without abnormal contrast enhancement.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Additionally, diffuse dilatation of the left renal vein (thick arrow) was noted before intravenous contrast administration.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Intravenous contrast administration confirmed dilated left renal vein containing diffuse filling defect (thin arrows) corresponding to thrombosis, which extended into the inferior vena cava lumen (arrow).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    The left renal vein thrombosis extended into the inferior vena cava lumen (arrow). Note nonenhancing left adrenal enlargement (arrowhead).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;
     
     
  • Figure 4
    Follow-up unenhanced and post-contrast multidetector CT
     

    Two months after initial hospitalization, CT showed significant decrease of size (2.5x.1.8 cm) and attenuation (20 HU) of the left adrenal enlargement (arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Two months after initial hospitalization, CT showed significant decrease of size (2.5x.1.8 cm) and attenuation (20 HU) of the left adrenal enlargement (arrowheads).

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Near-complete resolution of the extensive venous thrombosis was noted, with patent inferior vena cava and a small residual filling defect (thin arrows) in the left renal vein.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;

    Near-complete resolution of the extensive venous thrombosis was noted, with patent inferior vena cava and a small residual filling defect (thin arrows) in the left renal vein.

     
    Area of Interest: Adrenals; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis;
     
     
Requested to exclude thromboembolism, CTA showed normal lung volumes without active pleuropulmonary changes (a).
 
CTA excluded signs of pulmonary embolism and acute aortic diseases. Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units) enlargement of the left adrenal gland (arrowheads) was noted.
 
Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) was detected. Note associated stranding of ipsilateral periadrenal fat (*).
 
Incidentally, a 4x3 cm hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) was detected. Note associated stranding of ipsilateral periadrenal fat (*).
 
The hyperattenuating (55 Hounsfield units, HU) enlargement of the left adrenal gland (arrowhead) did not enhance after intravenous contrast. Note associated stranding of ipsilateral periadrenal fat (*).
 
Ultrasound confirmed the ovoid-shaped left adrenal enlargement (caliper), measuring approximately 4x3 cm, with unspecific hypoechoic appearance.
 
Five days after admission, repeated CT showed partial regression of periadrenal fat stranding (*); the left adrenal enlargement (arrowheads) showed stable size, slightly more demarcated margins, minimal decrease in attenuation (48-50 HU).
 
The left adrenal enlargement (arrowheads) showed stable size, slightly more demarcated margins, minimal decrease in attenuation (48-50 HU), without abnormal contrast enhancement.
 
Additionally, diffuse dilatation of the left renal vein (thick arrow) was noted before intravenous contrast administration.
 
Intravenous contrast administration confirmed dilated left renal vein containing diffuse filling defect (thin arrows) corresponding to thrombosis, which extended into the inferior vena cava lumen (arrow).
 
The left renal vein thrombosis extended into the inferior vena cava lumen (arrow). Note nonenhancing left adrenal enlargement (arrowhead).
 
Two months after initial hospitalization, CT showed significant decrease of size (2.5x.1.8 cm) and attenuation (20 HU) of the left adrenal enlargement (arrowheads).
 
Two months after initial hospitalization, CT showed significant decrease of size (2.5x.1.8 cm) and attenuation (20 HU) of the left adrenal enlargement (arrowheads).
 
Near-complete resolution of the extensive venous thrombosis was noted, with patent inferior vena cava and a small residual filling defect (thin arrows) in the left renal vein.
 
Near-complete resolution of the extensive venous thrombosis was noted, with patent inferior vena cava and a small residual filling defect (thin arrows) in the left renal vein.
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version