Radiological Diagnosis of Renal Thrombosis in Children

Clodagh      Sweeney; John      M Kirby

Abstract

Renal thrombosis has multiple potential causes and a variety of imaging techniques can be used to make the diagnosis. Hypercoagulable states, ranging from hereditary thrombophilia to dehydration, may result in thrombosis in previously healthy renal veins. Abnormal vasculature, including a spectrum of primary vascular disorders, such as stenosis or vasculitis, may result in arterial or venous thrombosis. Traumatic injury to the vascular pedicle or dissection may also cause thrombosis.

Renal vein thrombosis is an uncommon but potentially serious condition that may result in acute complications such as pulmonary embolus and acute renal failure, or may lead to chronic kidney disease and hypertension. Until relatively recently, RVT could only be confidently confirmed or excluded with selective renal venography, however ultrasound is now the imaging method of choice for neonatal and pediatric RVT [1-4]. A spectrum of grey-scale, and Doppler imaging features has been described for the acute and late phases of the condition. Some authors have reported specific sonographic features that might predict poor outcome and renal atrophy [4, 5].

Magnetic resonance imaging provides accurate diagnostic evaluation of renal vasculature, particularly in the assessment of renal masses, but is typically reserved for those cases where the Doppler findings are inconclusive. In general, computed tomography (CT) diagnostic yield is comparable to magnetic resonance imaging (MRI). The requirement for IV contrast and significant radiation dose should be balanced against the potential need for general anaesthesia as well as institutional availability and expertise.

Keywords: Thrombosis, renal vein thrombosis, diagnosis, ultrasound, computed tomography, magnetic resonance angiography.

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