Accepted Manuscript

Title: Isolated Renal Sinus Lymphangiectasia – Close Mimic of Pelviureteric

Junction Obstruction and Hydronephrosis

Author: Venkatraman Indiran, P.Sathish Prabhu, Prabakran Maduraimuthu

PII: S0090-4295(15)00948-6
DOI: http://dx.doi.org/doi:10.1016/j.urology.2015.10.008
Reference: URL 19434

To appear in: Urology

Received date: 13-8-2015

Accepted date: 1-10-2015

Please cite this article as: Venkatraman Indiran, P.Sathish Prabhu, Prabakran Maduraimuthu,
Isolated Renal Sinus Lymphangiectasia – Close Mimic of Pelviureteric Junction Obstruction and
Hydronephrosis, Urology (2015), http://dx.doi.org/doi:10.1016/j.urology.2015.10.008.

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Images in Clinical Urology

Isolated renal sinus lymphangiectasia – Close mimic of pelviureteric junction obstruction and

hydronephrosis

Authors

1. Venkatraman Indiran

First author and Corresponding author

Associate Professor, Department of Radiodiagnosis

SREE BALAJI MEDICAL COLLEGE AND HOSPITAL

7 Works Road, Chromepet, Chennai, Tamilnadu, India, PIN 600044

Phone: + 044 22653429

Mobile: + 91 9443067358

Email: ivraman31@gmail.com

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2. P.Sathish Prabhu

Senior Resident, Department of Radiodiagnosis

SREE BALAJI MEDICAL COLLEGE AND HOSPITAL

7 Works Road, Chromepet, Chennai, Tamilnadu, India, PIN 600044

3. Prabakran Maduraimuthu

Professor and HOD, Department of Radiodiagnosis

SREE BALAJI MEDICAL COLLEGE AND HOSPITAL

7 Works Road, Chromepet, Chennai, Tamilnadu, India, PIN 600044

Keywords

Lymphangiectasia ; renal sinus ; hydronephrosis ; Computed Tomography (CT)

Dear Editor,

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I, Dr. Venkatraman Indiran, as first and corresponding author submit this manuscript titled ‘Isolated

renal sinus lymphangiectasia – Close mimic of pelviureteric junction obstruction and hydronephrosis’

to your esteemed journal for publication under ‘Images in Clinical Urology’ section.

Conflicts of interest: Nil.

Financial support : Nil

Thanking You

Dr. Venkatraman Indiran

Abstract

Renal lymphangiectasia is a rare disorder which may present as perirenal / peri pelvic

collection. Isolated renal sinus lymphangiectasia is a close differential diagnosis for

pelviureteric junction obstruction on ultrasound, but can be resolved without ambiguity

using Computed Tomography (CT) and magnetic Resonance Imaging (MRI). Here we

describe such a case, where imaging helped avoid unnecessary confusion

A 48 year old woman came with mild lower abdominal pain. There was no dysuria /fever/

hypertension. Ultrasound revealed intercommunicating cystic spaces in bilateral renal

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sinus region without ureteric dilatation (Figure 1). Bilateral pelviureteric junction

obstruction was considered. CT scan revealed symmetrical large cystic lesions with

lobulated margins in bilateral renal sinus, not communicating with pelvicalyceal system

(Figure 2), prompting diagnosis of isolated renal sinus lymphangiectasia. MRI revealed

T1 hypointense and T2 hyperintense cystic lesion in bilateral renal sinus (Figure 3). As

patient was asymptomatic, follow-up was advised. Repeat CT after 1 year showed no

change in lesion size.

Renal lymphangiectasia, a rare benign malformation involving perirenal, peripelvic and

intrarenal lymphatic system of kidneys [1], may affect any age; be unilateral or bilateral

with no gender predilection [2, 3]. It may be asymptomatic or present with pain,

distension or renal dysfunction [1]. Ultrasound differential diagnoses for renal sinus

lymphangiectasia are pelviureteric junction obstruction and polycystic kidney disease

[2]. Contrast enhanced CT is exquisite in delineating the lesion and collecting system

leaving no ambiguity. MRI can delineate the pathology with [2] or without contrast. Fluid

aspiration may demonstrate high renin [1]. Treatment options include cyst aspiration,

sclerosant injection, marsupialization and nephrectomy [1,4].

References

1: Rastogi R, Rastogi V. Computed tomographic scan in the diagnosis of bilateral renal

lymphangiectasia. Saudi J Kidney Dis Transpl. 2008 Nov;19(6):976-9. PubMed PMID:

18974588.

2. Mejía J; López J; Aldana N; Uribe M; Mazzaro M. Renal lymphangiectasia. MDCT and

MRI findings. Rev Colomb Radiol. 2011; 22:(3):1-8

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3. Vasquez E, Kallen RJ, Shore RM, Lindgren BW. Pediatric renal lymphangiectasia:

importance of recognition and accurate renal imaging. Urology. 2012 Aug;80(2):434-6.

doi:10.1016/j.urology.2011.12.045. Epub 2012 Feb 25. PubMed PMID: 22365448.

4. Meyyappan RM, Ravikumar S, Gopinath M. Laparoscopic management in a rare case of

bilateral perirenal lymphangiomatosis. Indian J Urol. 2013 Jan;29(1):73-4. doi:

10.4103/0970-1591.109992. PubMed PMID: 23671373; PubMed Central PMCID:

PMC3649608.

Legends

Figure 1A and 1B: Ultrasound abdomen revealed intercommunicating cystic spaces in

the bilateral renal sinus region.

Figure 2: 2A Plain Axial CT section and 2B corticomedullary phase of CECT revealed

bilateral nearly symmetrical large cystic lesions with lobulated margins in bilateral renal

sinus (horizontal arrow). 2C and 2D Axial and coronal reformat sections in excretory

phase shows bilateral nearly symmetrical large cystic lesions with lobulated margins in

bilateral renal sinus not communicating with pelvicalyceal system (Vertical arrows in 2C).

2E Volume rendered images showed splaying of bilateral pelvicalyceal system with no

hydroureteronephrosis.

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Figure 3: 3A Axial T1 weighted section and 3B coronal thick slab T2 weighted section in

MRI revealed symmetrical T1 hypointense and T2 hyperintense cystic lesion in bilateral

renal sinus.

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