Transhepatic venous collaterals arising from inferior vena caval extension of renal cell carcinoma

Abstract

A 49-year-old woman presented with intermittent gross haematuria and transitory oedema of both legs. Physical examination and all routine laboratory values were normal. IVU showed rapid uptake and a compressed right renal pelvis. Abdominal CT revealed a right renal tumour and a tumour thrombus in the inferior vena cava (IVC) which reached the level of the hepatic veins ( Fig. 1). Arteriography detected extensive neovascularity and a striated pattern associated with a tumour thrombus. Inferior vena cavography clearly depicted transhepatic venous collaterals and a lobulated filling defect, but few retroperitoneal pathways (Fig. 2a). The venous phase of superior mesenteric arteriography revealed that the structure of the portal branch clearly diCered from that of the aCerent vein. MRI confirmed it to be the large