History
A 40-year-old man had crampy pain in the left flank. This pain had an acute onset the previous evening, and the patient was afebrile. The left side of the abdomen was tender to deep palpation, but there was no rebound tenderness or palpable mass. Urinalysis demonstrated proteinuria without hematuria, bacteriuria, or pyuria. Figure 1 shows a 30-minute delayed roentgenogram from the excretory urogram. There were no abnormal calcifications on the scout roentgenogram. The left kidney now measures 1 cm longer than on a previous urogram four months earlier. The size of the right kidney is unchanged.
Diagnosis
Left renal vein thrombosis.
Comment
This urogram demonstrates extremely poor visualization of the left pelvocalyceal system and left ureter, indicating diminished function. This, combined with the fact that the left kidney has enlarged since the earlier examination, should strongly suggest renal vein thrombosis.The definitive study is selective renal phlebography (Fig 2,