case_images: PMC10540703_01
case_images: (a) US coronal oblique plane on the left flank, demonstrating enlargement and increased cortical echogenicity of the left kidney, with a thick perirenal hematoma (arrowheads). (b) US demonstrating an associated left adrenal hematoma, with hypoechoic areas of liquefaction.
case_images: jbsr-107-1-3263-g1.jpg
case_images: PMC10540703_01_jbsr-107-1-3263-g1.jpg
case_images: F1
case_images: There was also an increased left kidney cortical echogenicity and a thick perirenal hematoma extending continuously to the left adrenal gland area (Figure 1a, 1b).
case_images: (a) US axial plane of the left flank, demonstrating the enlarged left kidney (LK) and left renal vein (LRV), filled with hypoechoic content. (b) US axial plane of the abdomen, demonstrating the asymmetric kidneys (RK, LK) and the inferior vena cava (IVC) filled with hypoechoic content. (c) US sagittal plane demonstrating the enlarged suprarenal IVC, filled with hypoechoic content (arrows).
case_images: jbsr-107-1-3263-g2.jpg
case_images: PMC10540703_01_jbsr-107-1-3263-g2.jpg
case_images: F2
case_images: There was an increased caliber of the left renal vein (LRV) and the inferior vena cava (IVC), both filled with hypoechoic content (Figure 2a-2c).
case_images: (a) Color Doppler on the left kidney (LK) revealing an absence of venous flow in the lesser tributary veins and in the main renal vein, and a reduced flow in the main renal artery, with exuberant arterial flow in the contralateral renal artery (RRA), aorta (Ao) and iliac branches (I). (b) Color and spectral Doppler on the left kidney revealing a decreased diastolic flow and increased resistance index (RI) in the renal artery.
case_images: jbsr-107-1-3263-g3.jpg
case_images: PMC10540703_01_jbsr-107-1-3263-g3.jpg
case_images: F3
case_images: Color Doppler imaging revealed an absence of venous flow in the LRV and the lesser tributary veins of the left kidney (Figure 3a), as well as the IVC until the level of the hepatic veins, confirming complete thrombosis. Spectral Doppler of the left renal artery showed a decreased diastolic flow and increased resistance index (Figure 3b).
case_images: (a) Follow-up US two weeks later revealing a reduction in the perirenal hematoma thickness (arrowheads), and a decreased kidney cortico-medullary differentiation, with an intermedullary streaking pattern (arrows). (b) Doppler imaging two weeks later demonstrating an almost complete loss of vessel flow in the left kidney.
case_images: jbsr-107-1-3263-g4.jpg
case_images: PMC10540703_01_jbsr-107-1-3263-g4.jpg
case_images: F4
case_images: Follow-up imaging two weeks later revealed a reduced size of the left kidney, with loss of its cortico-medullary differentiation, and an intermedullary streaking pattern composed of hyperechoic streaks surrounding hypoechoic medullas (Figure 4a). The arterial evaluation demonstrated a progressive flow loss in the main renal artery (Figure 4b).
case_images: (a) US one year later revealing an utterly atrophic left kidney. (b) US one year later revealing a filiform hypoechoic IVC (arrows).
case_images: jbsr-107-1-3263-g5.jpg
case_images: PMC10540703_01_jbsr-107-1-3263-g5.jpg
case_images: F5
case_images: One year later, the left kidney was atrophic (Figure 5a), and the IVC was filiform, with no internal flow (Figure 5b).