URORADIOLOGY


Case 9 :

A 25-year-old male presents with vague abdominal discomfort. What is the diagnosis?

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Diagnosis

Renal lymphoceles (Renal lymphangiectasia): Study shows enlarged kidneys with subcapsular perirenal fluid collections.

Discussion

Introduction

Renal lymphangiectasia is a rare disorder. Patient symptoms described in the literature include hematuria, flank pain, and abdominal pain. The condition has been found in children and in adults. The origin of this disorder is speculative. There is a familial association in some cases, which argues for a congenital cause. Some argue for an acquired cause, which suggests that the lymphatic vessels may become blocked owing to inflammation or other obstruction and so cause lymphatic ectasia. Other names for this condition have included "renal lymphangiomatosis", "renal lymphangioma", "peripelvic lymphangiectasia", and "renal peripelvic multicystic lymphangiectasia".

"Renal lymphangiectasia" is the preferred name, given that the disorder is characterized by ectatic perirenal, peripelvic, and intrarenal lymphatic vessels.

Imaging

Imaging findings of renal lymphangiectasia include peripelvic cysts and perirenal fluid collections. The finding of retroperitoneal fluid collections, presumably dilated lymphatic vessels, is a more variable finding but has been noted in multiple cases in the literature. Renal lymphangiectasia has been found associated with renal venous thrombosis and hypertension. Ascites and large perinephric fluid collections have been found and are exacerbated by pregnancy.

The diagnosis of renal lymphangiectasia can be confirmed with needle aspiration of chylous fluid from the perinephric fluid collections. Treatment is not usually necessary. Complicated cases may be treated with nephrectomy, percutaneous drainage, or marsupialization.

References

http://radiology.rsnajnls.org/cgi/content/full/219/2/442

Dr. Sanjeev Mani, Bandra Holy Family Hospital, Mumbai