MRI findings of renal lymphangiectasia

Renal Lymphangiectasia: The Transcending of Serendipity

Renal lymphangiectasia, a rare entity of the renal lymphatic system affecting both genders and all ages, can manifest bilaterally or unilaterally and has been referred to by various terms, such as renal lymphangiomatosis, renal lymphangioma, and others. Distinguishing this condition from common pathologies, such as polycystic kidney disease or hydronephrosis, is crucial. This article presents an innovative clinical case of unilateral renal lymphangiectasia in a 67-year-old woman with a relevant medical history. Detection was achieved by ultrasound in primary care using the point-of-care ultrasound (POCUS) technique under the focused assessment with sonography in trauma (FAST) protocol, revealing findings suggestive of renal lymphangiomatosis. This case highlights the utility of advanced technologies, such as bedside ultrasound, in addressing and transforming the approach to rare medical conditions, offering a compelling reminder of the positive influence of technological innovation in clinical practice.

Renal Lymphangiectasia: An Unusual Mimicker of Cystic Renal Disease - A Case Series and Literature Review

Cystic renal lesions are commonly seen on a daily basis in abdominal imaging. Even though most cystic renal lesions are benign simple cysts, complex and multifocal cystic renal diseases are also common with a vast number of differentials. One of the rare mimickers of this condition is renal lymphangiectasia, and the disease can be diagnosed if radiologists are aware of the imaging findings, and this can help the physician to offer the appropriate treatment. We report a case series of five cases in our hospital and also review the literature on renal lymphangiectasia, including its pathophysiology, clinical presentation, imaging appearances, complications, treatment, and differentials.

Contrast enhanced ultrasound for the diagnosis of bilateral renal lymphangiectasia: literature review and contrast enhanced ultrasound findings

Renal lymphangiectasia (RLmp) is a rare benign lymphatic malformation which should be distinguished from other more common pathologies. Ultrasound (US) examination can define the first diagnostic suspicion, but the definitive diagnosis is usually reached with a second level imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). We herein describe for the first time in literature, the use of the contrast enhanced ultrasound (CEUS) in disclosing the nature of peri-renal anechoic lesions in a 27-years old woman, that were initially confused with parenchymal cysts at B-Mode US. The diagnosis of RLmp may be particularly demanding due to its rarity and different clinical presentations. We suggest a possible role of CEUS as a real time, cost saving and easily accessible second level diagnostic tool, that can represent an appealing alternative in the diagnostic work up of suspected RLmp, respect to other imaging modalities.

Bilateral renal lymphangiectasia: radiological findings by ultrasound, computed tomography, and magnetic resonance imaging

Renal lymphangiectasia is a rare benign condition of the kidney without specific clinical presentations. Classic imaging findings are described in literature. Here, we present a case of renal lymphangiectasia with history of bilateral flank pain and abnormal renal function tests. The radiological appearance on ultrasound (US) and computed tomography (CT) showed features of bilateral renal lymphangiectasia but the patient refused invasive procedure for aspiration of the cysts. So, follow-up of the patient was done by magnetic resonance imaging (MRI). Imaging findings of our case on US, CT, and MRI are discussed along with details of the additional finding of dilated retroperitoneal lymphatic channels, cisterna chyli, as well as the thoracic duct.

Renal lymphangiectasia presenting with hypertension and polycythemia

We report a very rare case of renal lymphangiectasia, an accumulation of lymph in the renal lymphatic system secondary to obstruction. Our patient presented to his family doctor for an annual check-up which resulted with high blood pressure and polycythemia. An ultrasound was performed and revealed a large right perirenal collection. A year later, a controlled abdominal computed tomography scan showed a progression and compression of perirenal collection on the right kidney, as well as apparition of a left perirenal collection. Percutaneous drainage of both collections was unsuccessful. Laparoscopy-guided marsupialisation was performed and successful. Blood pressure lowered to normal range without medication. The patient's hemoglobin level decreased within normal range after 3 additional phlebotomies postoperatively.

Percutaneous drainage and sclerotherapy as definitive treatment of renal lymphangiomatosis

We report the technique and outcome of percutaneous drainage and sclerotherapy as primary treatment of renal lymphangiomatosis. Between January and May 2009, two patients presenting with symptomatic renal lymphangiomatosis were treated in our department by a minimally invasive modality combining percutaneous drainage with repeated sclerotherapy. We retrospectively analysed recurrence, complications and patient satisfaction. In this limited case series, percutaneous drainage and repeated sclerotherapy proved to be safe and effective for treating renal lymphangiomatosis. This procedure provides a minimally invasive option for selected patients, potentially avoiding a surgical procedure and any risk of complications.

Perinephric fluid collections due to renal lymphangiectasia

Fluid collections around the kidneys on cross-sectional imaging may be caused by urine, blood, pus, lymph, or plasma. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) can not only show and characterize the fluid, but also may help determine the underlying cause of the perinephric fluid collection, such as ureteric obstruction, kidney injury, infection, or renal lymphangiectasia. Renal lymphangiectasia is characterized by abnormal and ectatic lymphatic vessels within and around the kidneys. Dilated lymphatics may result in peripelvic cysts (intrarenal lymphangiectasia) and perinephric fluid collections (extrarenal lymphangiectasia), which can be visualized using US, CT, and MRI. Proper diagnosis on imaging helps in planning a conservative management approach to this benign condition, which requires intervention for only significant symptoms or complications. We describe a 60-year-old man with normal kidney function and bilateral perinephric fluid collections in whom renal lymphangiectasia was diagnosed noninvasively on the basis of characteristic findings on US, CT, and MRI.

Retroperitoneal lymphangiectasia-radiologic appearances, complications and management alternatives: a case report

Retroperitoneal lymphangiectasia is a very rare benign disorder of lymphatic system. The origin of this disorder is speculative. Clinical evolution and prognosis remains unclear. Ultrasound and cross sectional imaging findings are characteristic and diagnostic of the disease. Complications of RPL have been reported only in rare cases. The management alternatives range from pharmacological substitutes to surgical interventions in symptomatic cases.