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Abualrub AM, Malhes WM, Shehadeh MH, Omari FH, Tuqan AR, Ishtawi S, Hindi T. Bilateral Renal Lymphangiomatosis: A Case Report and Literature Review. Cureus 2024; 16:e58180. [PMID: 38741807 PMCID: PMC11089495 DOI: 10.7759/cureus.58180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
Renal lymphangiomatosis is a rare congenital condition characterized by the abnormal development of lymphatic channels in the kidney, resulting in cystic dilatations. While more commonly observed in children, it can occur in adults but is extremely rare. Clinical manifestations range from asymptomatic cases to symptoms such as abdominal pain, hypertension, and renal dysfunction. In this case report, we present a rare case of bilateral renal lymphangiomatosis in an eight-year-old male with high blood pressure. Renal ultrasound revealed bilateral kidney enlargement and perinephric hypoechoic collections with septations consistent with lymphangiomatosis. The diagnosis was confirmed through CT imaging which shows bilateral non-enhancing perinephric collections. As a part of the patient's management plan, bilateral perinephric cystic lesions were successfully aspirated without complications. In conclusion, accurate diagnosis is crucial for appropriate management decisions, and treatment primarily focuses on conservative measures to manage associated hypertension, reduce lymphatic fluid accumulation, and alleviate pain, reserving invasive interventions for severe cases or complications.
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Affiliation(s)
| | | | | | - Fadi H Omari
- Department of Medicine, Al-Quds University, Jerusalem, PSE
| | - Anas R Tuqan
- Department of Medicine, Al-Quds University, Jerusalem, PSE
| | - Shaima Ishtawi
- Department of Pediatrics, Palestine Medical Complex, Ramallah, PSE
| | - Tareq Hindi
- Department of Pediatric Nephrology, Augusta Victoria Hospital, Jerusalem, PSE
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Eskildsen DE, Guccione J, Menias CO, Shaaban AM, Morani AC, Shehata MA, Fagan RJ, Singer ED, Abdelaal MA, Jensen CT, Elsayes KM. Perirenal lymphatics: anatomy, pathophysiology, and imaging spectrum of diseases. Abdom Radiol (NY) 2023; 48:2615-2627. [PMID: 37269362 DOI: 10.1007/s00261-023-03948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite being rarely discussed, perinephric lymphatics are involved in many pathological and benign processes. The lymphatic system in the kidneys has a harmonious dynamic with ureteral and venous outflow, which can result in pathology when this dynamic is disturbed. Although limited by the small size of lymphatics, multiple established and emerging imaging techniques are available to visualize perinephric lymphatics. Manifestations of perirenal pathology may be in the form of dilation of perirenal lymphatics, as with peripelvic cysts and lymphangiectasia. Lymphatic collections may also occur, either congenital or as a sequela of renal surgery or transplantation. The perirenal lymphatics are also intimately involved in lymphoproliferative disorders, such as lymphoma as well as the malignant spread of disease. Although these pathologic entities often have overlapping imaging features, some have distinguishing characteristics that can suggest the diagnosis when paired with the clinical history.
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Affiliation(s)
- Dane E Eskildsen
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Akram M Shaaban
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mostafa A Shehata
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard J Fagan
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Emad D Singer
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Moamen A Abdelaal
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Corey T Jensen
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Lahfidi A, Traore W, Imrani K, Ayadi C, Nassar I, Billah NM. Perirenal cystic lymphangioma mimicking a renal cyst in an elderly patient: Case report. Int J Surg Case Rep 2022; 97:107403. [PMID: 35870216 PMCID: PMC9403095 DOI: 10.1016/j.ijscr.2022.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023] Open
Abstract
Cystic lymphangioma is a congenital benign lymphatic tumor commonly diagnosed in childhood. Cervical and axillary locations are the most usual, while retroperitoneal involvement is exceptional. Perirenal cystic lymphangioma may be revealed by urological signs or by incidental findings. Imaging plays an essential role in characterizing the tumor, however differential diagnosis with benign or malignant renal tumors is not always possible, thus requiring histological evidence. We report the case of a 50-year-old man who presented with a cystic lymphangioma of the left kidney revealed by lumbar pain with imaging features mimicking an exocortical developing renal cyst. The work has been reported in line with the SCARE criteria.
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Orouji Jokar T, Chidobem I, Khan N. Bilateral Renal Lymphangiectasia Associated With Polycythemia: A Rare Case Report. Cureus 2021; 13:e16130. [PMID: 34354877 PMCID: PMC8327252 DOI: 10.7759/cureus.16130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2021] [Indexed: 11/05/2022] Open
Abstract
Renal lymphangiectasia is a rare benign mesenchymal tumor of unclear etiology resulting from dilatation of perinephric lymphatic channels and formation of cystic masses. Polycythemia is a rarely associated finding with only five cases reported in the literature. We report a case of bilateral renal lymphangiectasia associated with polycythemia in a 38-year-old man who was managed conservatively with pain control. There are no clear guidelines for the management of renal lymphangiectasia; although most patients can be treated conservatively, some cases, whose diagnosis is unclear or develop complications, require definitive surgical excision.
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Affiliation(s)
- Tahereh Orouji Jokar
- Hematology and Oncology, Prime Healthcare, Saint Clare's Hospital, Denville, USA
| | - Ikechukwu Chidobem
- Internal Medicine, Prime Healthcare, Saint Clare's Hospital, Denville, USA
| | - Nazia Khan
- Internal Medicine, Prime Healthcare, Saint Clare's Hospital, Denville, USA
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A child with bilateral multiple renal cysts presenting with ascites and pleural effusion: Answers. Pediatr Nephrol 2019; 34:1543-1544. [PMID: 30790041 DOI: 10.1007/s00467-019-4198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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Chua N, Wolfe K, Mehta S, Lodge RN, Liyanage SH. Triparametric ultrasound in differentiating multicystic renal masses: a rare presentation of unilateral focal renal lymphangioma. Radiol Case Rep 2017; 12:731-737. [PMID: 29484059 PMCID: PMC5823298 DOI: 10.1016/j.radcr.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 12/21/2022] Open
Abstract
We describe a rare case of renal lymphangioma presenting as a focal unilateral multicystic renal mass and document the first reported use of triparametric ultrasound (B-mode, Doppler, and contrast-enhanced ultrasound) in its diagnosis and discrimination from other focal multicystic lesions. Renal lymphangiomas are rare, benign, typically developmental lesions composed of cystic dilatation of the lymphatic ducts, usually occurring bilaterally as perinephric collections or parapelvic cysts mimicking hydronephrosis. Radiologists have an important role in suggesting the diagnosis, as clinical presentation can be nonspecific. Management is usually conservative; however, nephron-sparing surgery may be recommended in symptomatic individuals.
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Affiliation(s)
- Nicholas Chua
- Radiology Department, Basildon University Hospital, Nethermayne, Basildon, Essex SS16 5NL, UK
| | - Konrad Wolfe
- Histopathology Department, Southend University Hospital, Essex, UK
| | - Sampi Mehta
- Department of Urology, Southend University Hospital, Essex, UK
| | - Richard N Lodge
- Department of Urology, Southend University Hospital, Essex, UK
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Zhang J, Jin H, Wang Y, Bai C, Han Y. A case of diffuse pulmonary lymphangiomatosis with unilateral lung invasion. Oxf Med Case Reports 2015; 2015:346-8. [PMID: 26512334 PMCID: PMC4622182 DOI: 10.1093/omcr/omv059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/22/2015] [Accepted: 09/24/2015] [Indexed: 11/23/2022] Open
Abstract
Diffuse pulmonary lymphangiomatosis (DPL) is a rare interstitial lung disease characterized by intrathoracic lymphatic system abnormalities often with involvement of both lungs. Here, we report a 24-year-old male patient with DPL initially located in one lung, presenting only with transient fever. Resection of the right middle and lower lobes was performed for diagnosis and complete removal of the lesions. The pathologic features shown by diffuse smooth thickening of the interlobular septa, bronchovascular bundles, infiltration of patchy ground glass opacities and specific immunohistologic D2-40 and CD34 positive staining confirmed the diagnosis of DPL. The patient did not show signs of relapse during the 2-year follow-up period, which suggests that surgery is an effective and reasonable method for treating DPL with relatively localized lesions.
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Affiliation(s)
- Jingxi Zhang
- Department of Respiratory Medicine , Changhai Hospital, the Second Military Medical University , Shanghai 200433 , China
| | - Hai Jin
- Department of Thoracic Surgery , Changhai Hospital, the Second Military Medical University , Shanghai 200433 , China
| | - Yang Wang
- Department of Pathology , Changhai, Hospital, the Second Military Medical University , Shanghai 200433 , China
| | - Chong Bai
- Department of Respiratory Medicine , Changhai Hospital, the Second Military Medical University , Shanghai 200433 , China
| | - Yiping Han
- Department of Respiratory Medicine , Changhai Hospital, the Second Military Medical University , Shanghai 200433 , China
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