|Case 9 :
A 25-year-old male presents with vague abdominal discomfort. What is the diagnosis?
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lymphoceles (Renal lymphangiectasia): Study shows enlarged kidneys with
subcapsular perirenal fluid collections.
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" is the preferred name, given that the
disorder is characterized by ectatic perirenal, peripelvic, and
intrarenal lymphatic vessels.
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.
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
Dr. Sanjeev Mani, Bandra Holy Family Hospital, Mumbai