Download Abstract Id : IRIA -1090

Bilateral Renal Lymphangiectasia - Case
Report
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ABSTRACT ID : IRIA -1090
Case history..
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 A 48 year old female came with the
complaints of mild dull aching lower
abdomen pain for past 2 months
 Past history:


No history of SHT/ Epilepsy/ TB / DM
No significant history in the past
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 Ultrasound abdomen done

Ultrasound examination revealed dilated
pelvicalyceal system without ureteric
dilatation and diagnosis of pelviureteric
junction obstruction was considered
RIGHT KIDNEY
LEFT KIDNEY
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CECT -KUB
 Computed tomography (CT) revealed large
hypodense non enhancing cystic lesions with
lobulated margins noted filling the renal sinus
region of both kidneys
 The lesion was exerting the mass effect and
stretching the pelvicalyceal systems of both
kidneys
 Otherwise both kidneys showed normal
enhancement and excretion
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Large hypodense cystic lesions with lobulated margins noted
filling the renal sinus region of both kidneys
PLAIN
CONTRAST
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The lesion was exerting the mass effect and stretching the
pelvicalyceal systems of both kidneys
PLAIN
CONTRAST
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MRI revealed multi lobulated cystic lesion appears hypointense on T1 & hyperintense on T2WI
lesion seen filling both renal parenchyma
T1 WI Axial
STIR COR
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 Volume rendered
image showed mild
streaching & distorted
pelvicalyceal system
No
hydroureteronephrosis
Differential diagnosis
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DDx for filling defects in renal sinus/Distorted
collecting system
 Renal lymphangiectasia
 Urinoma
 Polycystic kidney disease
 Lymphoma.
WHY LYMPHANGEICTASIA
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 USG demonstrates anechoic lesion in the renal
pelvis with out ureteric dilatation
 On CT, several lesions with fluid attenuation
found in the renal sinus;. Characteristically,
these lesions do not invade the adjacent
structures, although they cause displacement
 On MR, cystic lesions appearead hypointense in
T1 sequences,and hyperintense in T2 with the
presence of fine thin septations.
WHY NOT..
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 POLYCYSTIC KIDNEY DISEASE
 Polycystic kidneys show evidence of scattered
parenchymal cysts that may vary in size and may or may
not be associatedwith pancreatic or hepatic cysts.
 URINOMA
 Its bilateral, symmetricl,Asymtomatic & not obstructing
the collecting system.
 LYMPHOMA
 Masses are observed with greater levels of attenuation
than those found in renal lymphangiectasia.
Renal lymphangiectasia
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 Renal lymphangiectasia is a rare entity of the
renal lymphatics that occurs in both children
and adults.
 It may be unilateral or bilateral and has no
gender predilection.
 It is caused by an abnormal development of
the lymphatic structures, with single or
multilocular fluid-filled cavities, usually found in
the neck (75%-80%) and axillary (20%) regions.
Renal lymphangiectasia
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 other names such as
 Renal lymphangiomatosis
 Renal lymphangioma
 Parapelvic lymphangiectasia,
 Polycystic renal sinus
 Renal hygroma
Renal lymphangiectasia
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Pathophysiology..
 Pathophysiology of this is unclear,
 The lymphatic drainage of the kidneys, the renal
capsule and the perirenal tissues is
interconnected through several large lymphatic
trunks located inside the renal sinus.
 These lymphatic trunks drain into the paraaortic, para-caval and inter-aorto-caval lymph
nodes.
Renal lymphangiectasia
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Pathophysiology..
 There may be a developmental malformation
and derangement of the drainage of these
lymphatic trunks, leading to their dilatation and
the creation of cystic voids adjacent to the
renal sinus
 Some have suggested that it may represent the
benign neoplastic process.
IMAGING FEATURES..
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 The imaging characteristics depend on the site
and extent of the lymphatic involvement.
 USG may show
o Perirenal collection & peripelvic cysts
 Retroperitoneal fluid collection
 Ascites
 Echogenic renal parenchyma
IMAGING FEATURES..
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 CT demonstrates
 Perinephric
fluid collection
 Parapelvic /perirenal multiloculated cystic
lesions with septations
 If only the small intra-renal lymphatics are
compromised, the lesion may appear as a solid
renal lesion or with slight diffuse kidney
enlargement with no cystic space
 The diagnosis can be conformed with needle
aspiration chylous fluid from the perinephric fluid
collecition
Summary
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 Renal lymphangiectasia is a rare entity;
consequently, it is important for radiologists to
be familiar with its characteristics and different
forms of imaging appearance to diffentiate it
from pelviureteric junction obstruction.
 In that way, we will be able to provide clinicians
with the appropriate information required to
determine the most adequate treatment for
each individual patient
Thank you …!
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