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Case Reports
. 2018 Mar;97(13):e0284.
doi: 10.1097/MD.0000000000010284.

Color Doppler ultrasound diagnosis of intrarenal vein thrombosis: A rare case report and literature review

Yixiu Zhang  1 , Ying Wang, Jianchu Li, Sheng Cai
Affiliations
Case Reports

Color Doppler ultrasound diagnosis of intrarenal vein thrombosis: A rare case report and literature review

Yixiu Zhang et al. Medicine (Baltimore). 2018 Mar.

Abstract

Rationale: We present a case of intrarenal vein thrombosis (IRVT) diagnosed by ultrasound (US). To the best of our knowledge, this is the first reported case in the imaging literature.

Patient concerns: A 15-year-old boy with a 4-year history of thrombocytopenic purpura presented to the emergency room with a 2-day history of sudden-onset severe left flank pain associated with gross hematuria.

Diagnoses: Hypercholesterolemia, proteinuria, and elevated plasma creatinine level were present. The US examination showed obscurely structured, sparsely distributed arterial and venous flow signals, and an increased resistance index (RI) in a localized area. The diagnosis was acute renal failure and nephrotic syndrome accompanied by left IRVT.

Interventions: The patient was treated with anticoagulation therapy for 1 month.

Outcomes: Clinical symptoms were relieved. The US re-examination revealed that the arterial flow spectra had returned to normal. Also, more venous flow signals were observed in the involved area, suggesting thrombolysis.

Lessons: This previously unreported case should alert sonographers to include IRVT in the differential diagnosis of flank pain associated with hematuria. In such cases, both kidneys and different areas of the same kidney should be scanned and compared. Some features, including an obscure structure and an increased RI for the involved area indicate possible IRVT.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Upper pole of the left kidney was enlarged with an obscure structure.
Figure 2
Figure 2
Sparsely distributed artery and venous flow signals were present. Reverse diastolic flow and an increased resistance index (RI; 0.83–1.00) were observed in this area.
Figure 3
Figure 3
Normally distributed arterial and venous flow signals were present, and a normal resistance index (RI; 0.70–0.72) was observed in the lower pole of the same kidney.
Figure 4
Figure 4
After treatment, increased arterial and venous flow signals were observed in the same area. Normal waveforms were present, and the segmental artery resistance index (RI) had returned to the normal range (0.6–0.72).
Figure 5
Figure 5
Vascular tree grows normally in the normal kidney. Both the main and arcuate arteries are easily visualized.
Figure 6
Figure 6
Local area structure was enlarged and obscure.
Figure 7
Figure 7
Neovascularization was quite thin, rigid, and discontinuous.
See this image and copyright information in PMC

References

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    1. Zubarev AV. Ultrasound of renal vessels. Eur Radiol 2001;11:1902–15. - PubMed
    1. Gonzalez R, Schwartz S, Sheldon CA, et al. Bilateral renal vein thrombosis in infancy and childhood. Urol Clin North Am 1982;9:279–83. - PubMed

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