Presentation
Left flank pain with microscopic hematuria. History of gastric bypass surgery 3 weeks ago.
Patient Data
No radiopaque renal or ureteric calculi or hydronephroureter is seen on either side. Mildly enlarged left kidney showing mildly decreased parenchymal enhancement. Marked fat stranding around the left kidney, adrenal gland and around the renal vein. No perinephric fat stranding is noted on right side.
Relatively enlarged non-opacified left renal vein, suggestive of acute renal vein thrombosis. Part of the thrombus is seen extending into distal left gonadal vein just at its junction with the renal vein; the remaining gonadal vein is patent and well opacified. IVC and right renal vein are patent.
Two small poorly enhancing areas are seen at the upper and lower pole of left kidney which are suspicious for infarcts.
Small focal hypodensity, likely a hemangioma in right hepatic lobe.
Multiple surgical staples are seen around the stomach, consistent with history of recent gastric bypass surgery. No free fluid, collection or pneumoperitoneum is seen.
Relatively enlarged, non-opacified right renal vein denoting renal vein thrombosis with extension of the thrombus to the right renal vein- IVC junction. Associated relative enlargement and mildly decreased and heterogenous parenchymal enhancement of the right kidney with significant right perinephric and retroperitoneal fat stranding and free fluid.
Minimal free fluid is also seen in the pelvis.
Markedly atretic left renal vein with formation of multiple collaterals.
Case Discussion
The patient underwent extensive investigations and was found to have protein C, protein S and antithrombin III deficiencies. Investigations also showed hypoalbuminemia. 4 months later (after the 2nd CT scan), left renal biopsy was also performed and histopathology showed early membranous nephropathy.
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