Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Images in Nephrology
20 (
2
); 114-115
doi:
10.4103/0971-4065.65309

Bilateral renal lymphangioma - An incidental finding

Department of Radiodiagnosis and Surgery, Pt. B D Sharma, PGIMS, Rohtak, Haryana, India

Address for correspondence: Dr. Shalini Agarwal, Department of Radiodiagnosis, Pt. BD Sharma, Post Graduate Institute of Medical Sciences Rohtak, India. E-mail: shaliniagarwaldr@rediffmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.

Renal lymphangiectasia is a very rare benign disorder of the renal lymphatics. It is known by many different names including renal lymphangiomatosis, parapelvic lymphangiectasia, hygroma renale and polycystic disease of the renal sinus.[1] The origin is unclear and it is generally regarded as a developmental malformation of the renal lymphatic system. It may be seen at any age. Familial association has been reported in some cases.[2] It can be confused clinically, radiologically, and surgically with autosomal dominant polycystic kidney disease in adults, and autosomal recessive polycystic disease in children. However, on imaging, these cysts are large, thin walled, parapelvic and central retroperitoneal in location. Renal parenchyma is relatively normal as against the other two conditions.[2] Clinically, it is usually asymptomatic and incidentally diagnosed.[1]

The complications include hematuria, ascitis, occasional deterioration in renal function and rennin dependent hypertension.[3] The treatment of asymptomatic cases is not required. When collections are very large and causing pressure symptoms, percutaneous drainage may be carried out.[1]

We report the case of a 28-year-old male patient who presented with mild dull aching pain abdomen for the past seven years. There was no other significant history in the past. An ultrasound was performed six years back with aspiration of approximately 20 ml fluid from the lesion for diagnostic purposes and he was diagnosed with renal lymphangioma. He was put on symptomatic treatment and asked to come for regular follow-up. During the present visit his renal functions were normal. Intravenous urography (IVP) revealed normal function bilaterally. However, the calyces were distorted [Figure 1].

IVU image taken at 15 minutes reveals distortion of calyceal outline
Figure 1
IVU image taken at 15 minutes reveals distortion of calyceal outline

Ultrasonography (USG) revealed multiple cysts in the perirenal and peripelvic location, on both sides, distorting the renal outline [Figure 2].

Axial USG image of the right kidney reveals multiple cysts in the perirenal region and the region of the pelvis
Figure 2
Axial USG image of the right kidney reveals multiple cysts in the perirenal region and the region of the pelvis

Computed tomography (CT) and magnetic resonance imaging (MRI) revealed that the cysts were non-enhancing and were of cystic density on CT, [Figure 3] while they were of hypo-intermediate signal intensity on T1-weighted images and hyper intense on T2-weighted images [Figures 4 and 5]. On no imaging modality was the parenchyma of the kidneys involved, however, it appeared markedly reduced in volume at the present visit. In view of the apparent parenchymal compromise, approximately 600 mL of chylous fluid was drained from both sides. The aspirated fluid was rich in protein and contained rennin. On microscopic examination only a few lymphocytes were seen, while no organism was isolated on culture of the fluid.

Reformatted contrast enhanced coronal CT image reveals non enhancing extra-parenchymal hypo dense cysts in the perirenal region and the region of the pelvis of both the kidneys (more on the left side) causing distortion of the underlying parenchyma without involving it
Figure 3
Reformatted contrast enhanced coronal CT image reveals non enhancing extra-parenchymal hypo dense cysts in the perirenal region and the region of the pelvis of both the kidneys (more on the left side) causing distortion of the underlying parenchyma without involving it
Axial non-contrast enhanced T1-W MR scan at the level of the kidneys reveals that the cysts are of hypo-intermediate signal intensity
Figure 4
Axial non-contrast enhanced T1-W MR scan at the level of the kidneys reveals that the cysts are of hypo-intermediate signal intensity
Coronal T2-W MR scan at the level of kidneys reveals that the cysts are of hyper intense signal intensity
Figure 5
Coronal T2-W MR scan at the level of kidneys reveals that the cysts are of hyper intense signal intensity

We present this case to highlight the benign nature of this condition as against the conditions it can be confused with.

Source of Support: Nil

Conflict of Interest: None declared.

References

  1. , , , , , , . Renal lymphangiectasia. Br J Radiol. 2007;80:117-8.
    [Google Scholar]
  2. , , , , . Exacerbation of familial renal lymphangiomatosis during pregnancy. AJR Am J Roentgenol. 1988;151:965-6.
    [Google Scholar]
  3. , , , , , . Retroperitoneal lymphangiectasia associated with bilateral renal vein thrombosis. Nephrol Dial Transplant. 1997;12:1701-3.
    [Google Scholar]

Fulltext Views
281

PDF downloads
464
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections