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Case of the Month

January 2008

Patient Data: 71 year old male

Clinical Info: Hematuria


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Longitudinal image of the inferior vena cava with soft tissue structures


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Transverse image of the inferior vena cava with soft tissue structures


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Longitudinal image of the right renal vein filled with soft tissue structures, slightly lateral to the inferior vena cava


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Transverse image of the right renal vein and inferior vena cava with soft tissue structures


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Longitudinal image of the right kidney with a large tumor mass in the lowerpole


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CT scan at the level of the right reanal vein with tumor thrombus in the renal vein and the inferior vena cava


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CT scan showing the large renal cell tumor Diagnosis: Renal cell carcinoma invading the renal vein and inferior vena cava Renal cell tumors in the right kidney invade the inferior vena cava through the renal vein sooner than renal cell tumors on the left side. In case of tumor invasion of the left renal vein in males, impaired venous drainage of the left spermatic vein can occor, resulting in a varicocele. Also in case of tumor thrombus it is often possible to detect tumor vascularization with color doppler, as is shown in the next patient with a large renal cell carcinoma on the left side, who presented with a large varicocele.


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Transverse image with a dilatated left renal vein filled with tumor thrombus


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Color doppler showing tumor vascularization


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The patient presented with a large varicocele on the left side

For more cases of renal cell tumor invasion see:

References
Schwerk WB, Schwerk WN, Rodeck G. Venous renal tumor extension: a prospective US evaluation. Radiology. 1985 Aug;156(2):491-5

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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