Geara Abdallah, Kamal Leila, El-Imad Badiaa, El-Sayegh Suzanne
Department of Internal Medicine, Staten Island University Hospital, Seaview Avenue, Staten Island, New York, USA.
J Med Case Rep. 2010 Mar 23;4:93. doi: 10.1186/1752-1947-4-93.
We present a case of pyelovenous backflow after nephrostomy. To the best of our knowledge, this is the first documented case of renal vein visualization after a nephrostomic placement.
A 55-year-old Caucasian man presented with symptoms of pyelonephritis with an obstructing ureteral stone. A nephrostomy was performed. During an injection of contrast agent in his left caliceal system, his left renal vein was visualized. A repeat pyelography with an injection contrast material at low pressure failed to show the same finding. This radiological finding is due to the occurrence of "pyelovenous backflow".
This phenomenon is usually described in the setting of renal vein thrombosis, renal vein hypertension due to the "nutcracker phenomenon", or a reduced renal blood flow. Examination by microscopy shows the presence of tears in the fornix of the pelvic cavity that extend into the kidney parenchyma. Five types of renal backflow are described in the literature: pyelovenous, pyelolymphatic, pyelotubular, pyelointerstitia and pyelosinus. Injection of contrast material at high pressure may cause a fornix to flow into the tubules, or cause its rupture and flow into the venous system.
我们报告一例肾造瘘术后肾盂静脉逆流的病例。据我们所知，这是肾造瘘置管后首次记录到肾静脉显影的病例。
一名55岁的白人男性因肾盂肾炎症状伴输尿管结石梗阻前来就诊。进行了肾造瘘术。在向其左肾盂系统注射造影剂时，其左肾静脉显影。在低压下重复注射造影剂进行肾盂造影未能显示相同结果。这一放射学表现是由于“肾盂静脉逆流”的发生。
这种现象通常在肾静脉血栓形成、因“胡桃夹现象”导致的肾静脉高压或肾血流量减少的情况下出现。显微镜检查显示盆腔穹窿处存在延伸至肾实质的撕裂。文献中描述了五种类型的肾逆流：肾盂静脉逆流、肾盂淋巴逆流、肾盂肾小管逆流、肾盂间质逆流和肾盂窦逆流。高压注射造影剂可能导致穹窿流入肾小管，或导致其破裂并流入静脉系统。
