Pediatric Renal Vein Thrombosis

  • Etiology:
    — Neonatal dehydration
    — Indwelling venous catheter placement
    — Shock
    — Nephrotic syndrome
    — Abnormal coagulation
    — Malignancy (Wilms tumor)
  • Imaging:
    — Acutely see enlarged hypoperfused kidney along with thrombus in inferior vena cava and or renal vein
    — Chronically see calcification of thrombus and shrunken kidney
    — In neonates thrombi begin in small venules and propagate toward hilum thus renal parenchyma abnormalities often present without clear visualization of thrombus and flow is rapidly re-established in main renal vein and intrarenal vessels so there may be variable flow in main renal vein – may be present or decreased or absent
  • DDX:
  • Complications: Decreased renal function
  • Treatment:
  • Clinical:
    — Presents with hematuria or palpable flank mass or proteinuria or decreased renal function
    — Can be associated with adrenal hemorrhage
    — May be seen in infant of a diabetic mother
    — 66% on left and 33% on right

Radiology Cases of Acute Renal Vein Thrombosis

US of renal vein thrombosis
Sagittal US of the left kidney (above) and right kidney (below) shows an asymmetry in renal length, with the right kidney being more than 1.5 cm longer than the left kidney. Color doppler ultrasound (not provided) showed a non occlusive thrombus in the right renal vein.

Radiology Cases of Chronic Renal Vein Thrombosis

US of renal vein thrombosis
Sagittal US of the IVC (above) shows a calcified thrombus in the IVC which extended to the right kidney (below) and renal veins which was associated with right nephromegaly.
US of renal vein thrombosis
Sagittal US of the kidneys shows a small shrunken left kidney and an enlarged right kidney due to compensatory hypertrophy.