Renal Cell Carcinoma (RCC) with Delayed Excretory Phase
23 F year old female presents with hematuria. CT scan through the middle of the kidneys shows a normal right kidney in the excretory phase. There is a delay in the excretory phase of the right kidney with evidence of nutcracker effect on the renal vein by the SMA (dark blue arrowhead upper and lower image) with significant upstream distension of the left renal vein (teal blue arrowhead upper and lower images) The left kidney remains in corticomedullary phase (black arrowhead in lower image). The tumor is ill defined in this image but in part is appreciated (green arrowhead lower image).
Ashley Davidoff MD TheCommonVein.net 24165cL
Renal Cell Carcinoma (RCC) with Delayed Excretory Phase
Nutcracker Effect on LRV and Hydronephrosis
23 F year old female presents with hematuria. CT scan through the upper abdomen shows the upper pole of the right kidney in excretory phase (a, white arrowhead) and confirmed on lower images, while the left kidney is still in the cortico-medullary phase (a black arrowhead). Images b and c suggest potential contributing causes for the delay. Firstly, there is nutcracker effect on the left renal vein by the SMA, causing significant narrowing (b, blue arrowhead) . The green arrowhead in c, points to a large upper pole vascular mass known to be a clear cell carcinoma, which characteristically is hypervascular with A-V shunting, further contributing to increased flow in the partially obstructed left renal vein. Lastly there is associated upper pole hydronephrosis (c yellow arrowhead) further resulting in backward pressure and also to some extent contributing to the excretory delay.
Ashley Davidoff MD TheCommonVein.net 24164cL
23 F year old female presents with hematuria. CT scan through the middle of the kidneys shows a normal right kidney in the excretory phase. There is a delay in the excretory phase of the left kidney with evidence of nutcracker effect on the renal vein by the SMA (dark blue arrowhead upper and lower image) with significant upstream distension of the left renal vein (teal blue arrowhead upper and lower images) The left kidney remains in corticomedullary phase (black arrowhead in lower image). The tumor is ill defined in this image but in part is appreciated (green arrowhead lower image).
Ashley Davidoff MD TheCommonVein.net 24165cL
23 F year old female presents with hematuria. CT scan through the mid to lower portions of the kidneys shows a normal right kidney in the excretory phase. There is a delay in the excretory phase of the left kidney which remains in corticomedullary phase.
Ashley Davidoff MD TheCommonVein.net 24163c