The answer is renal vein thrombosis (RVT). Aheed Siddiqi has a nice article on imaging in renal vein thrombosis in emedicine. He describes the CT findings as including: decreased nephrographic attenuation, loss of corticomedullary differentiation, a low-attenuating thrombus in the renal vein, renal enlargement with persistent parenchymal opacification, and renal vein enlargement. The acute stage of RVT is characterized by capsular venous collaterals, thickening of the Gerota fascia, and pericapsular whiskering.
The association between renal vein thrombosis(RVT) and nephrotic syndrome was first described by Rayer in 1840. Membranous glomerulopathy is the commonest cause of NS associated with RVT. The presentation can be clinically silent (common), versus flank pain and macroscopic hematuria (less common and in younger patients). Anticoagulation with warfarin is done to prevent pulmonary embolism.
The Question
A 65 year old patient with new onset nephrotic syndrome approximately 5 months after the diagnosis of CLL. He has 6 grams of albuminuria. What's the diagnosis on this CT of the kidneys?
