Zhang Yixiu, Wang Ying, Li Jianchu, Cai Sheng
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2018 Mar;97(13):e0284. doi: 10.1097/MD.0000000000010284.
We present a case of intrarenal vein thrombosis (IRVT) diagnosed by ultrasound (US). To the best of our knowledge, this is the first reported case in the imaging literature.
A 15-year-old boy with a 4-year history of thrombocytopenic purpura presented to the emergency room with a 2-day history of sudden-onset severe left flank pain associated with gross hematuria.
Hypercholesterolemia, proteinuria, and elevated plasma creatinine level were present. The US examination showed obscurely structured, sparsely distributed arterial and venous flow signals, and an increased resistance index (RI) in a localized area. The diagnosis was acute renal failure and nephrotic syndrome accompanied by left IRVT.
The patient was treated with anticoagulation therapy for 1 month.
Clinical symptoms were relieved. The US re-examination revealed that the arterial flow spectra had returned to normal. Also, more venous flow signals were observed in the involved area, suggesting thrombolysis.
This previously unreported case should alert sonographers to include IRVT in the differential diagnosis of flank pain associated with hematuria. In such cases, both kidneys and different areas of the same kidney should be scanned and compared. Some features, including an obscure structure and an increased RI for the involved area indicate possible IRVT.
我们报告一例经超声（US）诊断的肾内静脉血栓形成（IRVT）病例。据我们所知，这是影像学文献中首次报道的病例。
一名患有血小板减少性紫癜4年的15岁男孩因突发严重左侧腰痛伴肉眼血尿2天就诊于急诊室。
存在高胆固醇血症、蛋白尿和血浆肌酐水平升高。超声检查显示局部区域结构模糊、动脉和静脉血流信号稀疏分布，阻力指数（RI）升高。诊断为急性肾衰竭和肾病综合征伴左侧IRVT。
患者接受了1个月的抗凝治疗。
临床症状缓解。超声复查显示动脉血流频谱已恢复正常。此外，在受累区域观察到更多静脉血流信号，提示血栓溶解。
这例此前未报道的病例应提醒超声检查人员在与血尿相关的腰痛鉴别诊断中考虑IRVT。在这种情况下，应扫描并比较双肾及同一肾脏的不同区域。一些特征，包括受累区域结构模糊和RI升高，提示可能存在IRVT。
