Imaging description

An infant presented with hematuria and thrombocytopenia. An ultrasound and subsequent CT scan demonstrated a thrombus in the right renal vein with an enlarged edematous right kidney (Fig. 59.1). The CT demonstrated diminished contrast enhancement of the medial/posterior aspect of the kidney (Fig. 59.1b) and a thrombus in the inferior vena cara (IVC), which extended into the right renal vein.

Importance

Renal vein thrombosis is the most common vascular pathology of the newborn kidney. Predisposing factors in a neonate include dehydration, sepsis, birth asphyxia, maternal diabetes, polycythemia, adrenal hemorrhage, and the presence of an indwelling catheter. In older children, renal vein thrombosis is associated with nephrotic syndrome and membranous glomerulonephritis, renal tumor (most commonly Wilms’ tumor; see Case 64), phlebitis, renal amyloidosis, hereditary thrombophilia, and other hypercoaguable states as well as trauma and burns. The prognosis for the affected kidney is very poor. Anticoagulant and fibrinolytic therapies rarely lead to successful reperfusion. In a few patients, the kidney may recover completely. However, much more frequently, late sequelae are observed, such as focal or complete atrophy of the kidney, impaired renal function, and arterial hypertension.