Rare case of an upper urinary tract carcinoma (UTUC) in renal pelvis and ureter associated to renal vein thrombosis: diagnostic imaging with CECT, MRI and CEUS

Abstract

A 58-year-old woman complaining of dyspnea and mild flank pain was admitted to our radiology department after undergoing ultrasonography in another institution. She showed hydronephrosis and left kidney swelling. We performed a contrast-enhanced computed tomography (CECT) that confirmed the hydronephrosis and revealed a widely hypoperfused left kidney, a concentric thickening of the proximal ureter, and a slight and diffuse thickening of the renal pelvic wall, with a hyperdense content in the unenhanced CT phase and poor contrast enhancement in the post-contrast phases. A proximal ipsilateral renal vein thrombosis was associated. Non-contrast magnetic resonance imaging confirmed the CECT findings. At the same time, we performed a contrast-enhanced ultrasonography examination, which proved to be helpful for the characterization of the lesion and for patient management.

Keywords: Contrast-enhanced computed tomography; Contrast-enhanced ultrasonography; Magnetic resonance imaging; Renal vein thrombosis; Urothelial carcinoma.

Fig. 1

In the CECT axial scans, in the arterial (30 s) and venous (80 s) phases (a, b), we note the presence of a wall thickening (white arrows) of the proximal ureter with poor enhancement in post-contrast phases, determining the upstream dilatation. The lesion (white arrows) is sufficiently detectable in sagittal (c) and coronal (d) scans. Periureteral fat tissue stranding is associated (a) (red arrow). Urographic (7 min) coronal (e) and sagittal (f) scans show calico-pielic dilatation and absence of contrast in the left urinary tract

Fig. 2

In the CECT axial scans, in the arterial (30 s) and venous (80 s) phases (a, b), we note a slight pelvic wall thickening (white arrows) with a slightly hyperdense pelvic content, with poor contrast enhancement. Two left para-aortic lymphadenopathies, the major of approximately 23 × 15 mm (red circles), were associated. Venous axial (c) and coronal (d) scans demonstrate proximal left renal vein thrombosis, without contrast enhancement (white arrows)

Fig. 3

MRI axial (a) and coronal (c) T2w sequences show the presence of a jutting and occluding lesion (white arrows) of the left proximal ureter (18 mm longitudinal diameter), hypointense, with restriction signs in the DWI (b value 1000 s/mm²) sequence (b)

Fig. 4

MRI axial (a, b) and coronal (c) T2w sequences, T1w in and out phase (d, e), and DWI (b value 1000 s/mm²) sequences f show calico-pielic dilatation with an inhomogeneous endopielic iso-hypointense material (white arrows) and b a thin fluid hyperintense central component (red arrow) in T2w (a–c). In T1w inhomogeneous endopielic iso-iperintense material (white arrows) (d, e). Endopielic restriction signs in the DWI sequence (f)

Fig. 5

MRI axial (a) and coronal (b) T2w sequences demonstrate a hyperintense area in the left lower pole consistent with a small abscess (2 cm) (white arrows)

Fig. 6

CEUS shows the presence of an occluding lesion a, b in the left ureteral lumen extended longitudinally for 2 cm with a caliper of 1 cm. The lesion (white arrows) has an early and persistent enhancement, with a high peak of enhancement

Fig. 7

CEUS demonstrates a pelvic wall thickening a–d of approximately 1 cm extended to the anteromedial pelvic wall for at least 2.5 cm (white arrows) with an early and persistent enhancement and a medium peak of enhancement compared with the surrounding renal parenchyma