Left adrenal tumor extending into the renal vein: surgical management with ipsilateral kidney preservation

Abstract

If single adrenal metastasis surgery is well admitted, no recommendation exists about the management of a renal vein tumor thrombus, even though the actual consensual attitude consists in a nephrectomy associated to an adrenalectomy. We report, here, the case of a 74-year-old man with a suspected adrenal metastasis of a lung carcinoma associated with a left adrenal and renal vein tumor thrombus treated by adrenalectomy and renal vein thrombectomy and ipsilateral kidney sparing. The postoperative computed tomography scan showed no thrombus in the left renal vein. Doppler ultrasound performed 1 month after adrenalectomy proved a good left renal vein flux. At 36 months of follow-up, the patient is alive without signs of recurrence.

Figure 1:

(1) Preoperative CT scan showing the adrenal mass (A) and in the renal vein a hypodense mass (B) corresponding to the renal vein tumor thrombus. (2) Postoperative CT scan showing the left kidney and its permeable vein. (3) Flow in the left renal vein on postoperative Doppler ultrasound.