Left renal vein varix simulating a pancreatic pseudocyst by sonography

Spira, Richard; Kwan, ES; Gerzof, SG; Widrich, WC

doi:10.2214/ajr.138.1.149

Cited by 14 publications

(2 citation statements)

References 12 publications

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“…The etiologic factors were thrombosis or compression of the renal vein (e.g., the "nutcracker syndrome")4 or portal hypertension with splenorenal shunts. 5 True renal vein aneurysms are related to congenital weakness of the venous wall because oflack of development of the media, as the findings in our case seem to suggest. Renal vein aneurysms are often clinically silent and detected by chance during investigations carried out for different reasons.…”

Section: Aneurysm Of the Left Renal Vein: A Case Reportsupporting

confidence: 63%

Aneurysm of the left renal vein: A case report

Irace¹,

Gossetti²,

Benedetti-Valentini³

et al. 1994

Journal of Vascular Surgery

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To the Editors:The visceral venous aneurysms are very uncommon and generally asymptomatic and are detected either at postmortem examination or by sonography, computed tomography scanning, magnetic resonance imaging, or venography carried out for different conditions and, exceptionally, during an abdominal procedure undertaken for other pathology.An aortobifemoral bypass graft repair was advised for aortoiliac chronic obstructive disease in a 61-year-old man. During the dissection up to the level of the left renal vein, a saccular true aneurysm of this vein was detected ( Fig. 1). Lateral clamping, resection of the aneurysm, and direct reconstruction by a running 5/0 polypropylene suture were carried out. A standard aortobifemoral bypass reconstruction was completed afterward.On histologic study (Fig. 2), the wall of the aneurysm showed marked medial atrophy with loss of elastic fibers; the intima was unremarkable. The wall of the renal vein around the aneurysm was normal.Some confusion exists in the literature about true aneurysms and varices of the renal veins l -3 : these entities should be differentiated on both anatomic and pathologic grounds and causative factors. In a true aneurysm the wall of the vein is quite thin because of marked medial atrophy, with loss of the elastic fibers and inconspicuous intima, whereas the histologic findings in a varix are both hypertrophy and thinning of the media with fibrous thickening.Although renal varices have been divided into secondary and idiopathic types, most of the cases reported in the literature are secondary in nature. The etiologic factors were thrombosis or compression of the renal vein (e.g., the "nutcracker syndrome")4 or portal hypertension with splenorenal shunts. 5 True renal vein aneurysms are related to congenital weakness of the venous wall because oflack of development of the media, as the findings in our case seem to suggest. Renal vein aneurysms are often clinically silent and detected by chance during investigations carried out for different reasons. Moreover, the possibility of spontaneous or iatrogenic rupture should also be kept in mind, because such an occurrence might be life threatening as a result of massive bleeding and difficulties in surgical repair.When an aneurysm of the renal vein is found during operation, it should be repaired, particularly when such a maneuver does not add much in time and trauma to the Fig. 1. Left renal vein saccular aneurysm detected during retroperitoneal dissection in aortobifemoral graft procedure.procedure. When a renal venous aneurysm is detected by any diagnostic means in a patient with unrelated symptoms, it seems reasonable to advise surgery when the associated symptomatic disease needs a surgical procedure and the venous repair is foreseen as feasible and without significant additional trauma.Although no clear evidence is available at present, we should assume that the larger the aneurysmal sac, the higher the chances of its rupture. Then if the overall balance is favorable, we believe that the surgical r...

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Section: Aneurysm Of the Left Renal Vein: A Case Reportsupporting

confidence: 63%

Aneurysm of the left renal vein: A case report

Irace¹,

Gossetti²,

Benedetti-Valentini³

et al. 1994

Journal of Vascular Surgery

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“…and their kidneys, testes and suprarenal gland as a routine after the section of the LRV. The blood flow to an organ detreases when the venous pressure nears the diastolic blood pressure.7 5 ,76The LLRV enables the inversion of the venous flow and venous hypertension in the kidney, testes and suprarenal gland.8, 14,21,50,60,67,[71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89] Baptista-Silva (1994)1 in more than 200 surgeries of the aorta, never had the need to perform a ligature of · LRV in elective surgery such as aneurysm emergencies or trauma to the aorta. In other words, when the approach to the aorta was difficult, he used other surgi cal techniques recommended by other authors, 39, 53,69,71,72,87,88,90-103 to facilitate the dissection of the aorta and avoid a LLRV.…”

Section: Introductionmentioning

confidence: 99%

Ligation of the left renal vein in epm1-wistar rats: functional and morphologic alterations in the kidneys, testes and suprarenal glands

et al. 1997

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Objective: The Iigation of the left renal vein (LLVR) in man is a contraversial procedure in view of the risks of lesion to the renal parenchyma. With the objecUve of studying the morphologic and functional alterations caused by these lesions, we conducted experimental research with rats. Material and Methods: 64 male adult EPM 1-WISTAR rats were used, divided into 8 groups -4 for . LLRV and four for control. Each LLRV group and corresponding control group were sacrificed progressively on the 7th, 15th, 30th and 60th day after the initial surgery. Results: We found morphofunctional alterations only in animais that underwent LLRV in the four periods of sacrifice. The proteinuria creatinine in serum, testosterone in serum and serum corticosterone in serum showed practically no alteration in relation to the normal values for rats. Statistically significant severe histological lesions were found in the kidneys and testes of the LLRV groups. Lesions in the suprarenal glands were also presentin these groups, but no sufficient to demonstrate statistical significance Conclusion: Based on these results we can conclude that the Iigation of the left renal vein is a procedure of high risk in these animais.

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