Abstract
Renal lymphangiectasia (RLM) is a rare condition characterized by dilatation of perirenal, parapelvic or intrarenal lymphatics. We report an unusual case of bilateral RLM in a 20-year-old Malay male who presented with 1 month duration of bilateral flank pain. Bedside ultrasound showed bilateral perinephric collections, which were further confirmed on computer tomography intravenous pyelogram (CT IVP). Other causes of perinephric collections were ruled out based on laboratory and radiological findings, and he was managed conservatively as for RLM with surveillance ultrasound kidneys at 3 to 6 monthly intervals.
Highlights
Renal lymphangiectasia (RLM) is hypothesized to result from developmental malformation of the renal lymphatic tissues leading to obstruction and accumulation of lymph in the subcapsular region or hilum
In RLM, there is impairment in the drainage of larger renal sinus lymphatic trunks with resultant dilatation of peripelvic and perinephric and intrarenal lymphatics [6]. It is usually asymptomatic and incidentally diagnosed on radiological imaging as perinephric or parapelvic fluid collections. It may be associated with pain, abdominal distension, hematuria, hypertension, and less commonly deterioration of renal function, renal vein thrombosis, polycythemia and pleural effusion
We present a case of renal lymphangiectasia, which was managed conservatively with surveillance imaging as the patient was asymptomatic
Summary
RLM is hypothesized to result from developmental malformation of the renal lymphatic tissues leading to obstruction and accumulation of lymph in the subcapsular region or hilum. Due to variable imaging findings, the differentials may be broad and diagnosis can be difficult. We aim to describe the clinical presentation, radiological findings, differentials and management of this condition using a case report and a review of the literature. Bedside ultrasound in the emergency department showed bilateral peripheral collections. CT IVP revealed bilateral symmetrical perinephric fluid collections measuring 12mm thick with some free fluid within the retroperitoneum and pericolic gutters (Figure 1A). There was no urinary calculus, solid renal mass or hydronephrosis. The delayed excretory phase showed no contrast extravasation into the collections (Figure 1B), thereby ruling out the possibility of urinoma
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