Successful management of vena caval compression due to a giant hydronephrosis by retroperitoneoscopic nephrectomy

Inferior Vena Cava Thrombus Secondary to Ureteropelvic Junction Obstruction with Severe Hydronephrosis

Benign external compression of the inferior vena cava (IVC) with distal thrombus formation is seldomly described in the medical literature. We report a case of external IVC compression by a dilated right renal pelvis and hydronephrotic kidney secondary to longstanding ureteropelvic junction (UPJ) obstruction found in a 68-year-old male. Management included therapeutic anticoagulation, IVC filter placement, attempted thrombectomy by interventional radiology and interval repeat imaging. This patient demonstrated complete resolution of the caval thrombus on repeat imaging 2 months following discharge. This case highlights the importance of interdisciplinary team coordination, a crucial component of this patient's management and eventual treatment plan. It is reasonable to manage patients with IVC thrombus with anticoagulation alone. In the modern era, angiointerventional techniques provide for minimally invasive approaches to the management of vascular disorders and minimize morbidity.

Severe ureteropelvic junction obstruction with massive hydronephrosis causing compression of the inferior vena cava

A 7-week-old girl presented with tachypnea and abdominal distension. Abdominal ultrasonography demonstrated a 16 cm cystic mass in the right abdomen. Contrast-enhanced T2-weighted magnetic resonance imaging revealed severe hydronephrosis of the right kidney with thinning of the renal parenchyma consistent with a massive ureteropelvic junction (UPJ) obstruction. A percutaneous nephrostomy tube was placed for decompression of her right kidney and 1270 ml of fluid was drained. The patient underwent an open pyeloplasty. Her follow-up renal ultrasonography demonstrated resolution of her severe hydronephrosis.

Giant hydronephrosis: still a reality!

OBJECTIVE

Giant hydronephrosis (GH) is a rare entity in both developed and developing countries with less than 500 cases reported in the literature. Delayed diagnosis and management of GH, can result in long-term complications like hypertension, rupture of the kidney, renal failure and malignant change. We aim to highlight the importance of this often neglected entity and build a consensus for its early diagnosis and management.

MATERIAL AND METHODS

Patients with GH were thoroughly worked up, managed and followed up between June 2013 and December 2015 and epidemiologic, radiological, perioperative and follow-up data was recorded.

RESULTS

A total of 35 patients (adults and children) were reported. Flank pain in adults and abdominal lump in children were the most common clinical presentation. Percutaneous nephrostomy tube was placed in all patients and detailed work up was done to reach final diagnosis. Pelvi-ureteric junction obstruction (PUJO) was the final diagnosis in 32 patients (91.4%). Kidneys were non-functioning in 13 cases (37.1%) so nephrectomies were performed. Reduction pyeloplasty with nephropexy was done in 21 patients (60%) with 81% success and 23.1% complication rates.

CONCLUSION

GH requires early diagnosis and management to prevent higher nephrectomy rate along with poor success rate of conservative surgery like pyeloplasty.

Giant obstructive megaureter causing contralateral ureteral obstruction and hydronephrosis: a first-time report

We report for the first time a "giant megaureter" causing symptomatic compression of the contralateral ureter in a 15-year-old girl. Extrinsic compression of the ureter by a contralateral giant hydronephrotic kidney, although rare, has been reported most commonly because of congenital pelviureteric junction obstruction. In this case, the possible etiology of megaureter, the differential diagnosis, and the clinical implications are discussed.