Renal tümör trombüsü

Özet

Renal hücreli karsinom, renal ven boyunca vena kava inferiora uzanan tümör trombüsü oluşturabilir; bu bulgu böbrek kitlesinin evresini ve cerrahi planlamayı değiştirir. Kontrastlı çok fazlı BT, trombüsün canlı tümör dokusu gibi kontrastlanıp kontrastlanmadığını, ven lümenini genişletip genişletmediğini ve kraniyal ucunun hangi anatomik seviyeye ulaştığını gösterir. Trombüsün yalnız renal vende mi kaldığı, VCI'ye girip girmediği ve diyafram ya da sağ atriyuma ulaşıp ulaşmadığı raporda açıkça belirtilmelidir. Uzanımın atlanması büyük damar tutulumunun ve ameliyat için gerekli hazırlığın eksik değerlendirilmesine yol açabilir.

Faz ve pencere

Arteriyel tanısal

Renal kitlenin kontrastlanma paternini izleyerek renal vene uzanan doku içinde benzer kontrastlanma arayın; arteriyel faz trombüsün canlı tümör dokusu niteliğini bland trombüsten ayırmaya yardım eder.

Portal tanısal

Renal ven ve VCI lümenini renal ostiumdan diyaframa ve görüntü alanındaki sağ atriyuma kadar takip edin; genişlemiş ven içinde devamlı yumuşak doku ve trombüsün üst ucunu gösterin.

Önerilen pencereler: Anjiyo (G 600 / M 150), Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Renal kitleyle aynı kontrastlanma davranışını gösteren yumuşak doku renal ven lümenine doğru kesintisiz uzanır.
• Tümörle dolu renal ven veya VCI genişlemiş olabilir; damar çapındaki artış tek başına tümör trombüsü tanısı koydurmaz.
• Trombüs renal ven ostiumundan VCI'ye geçebilir; sağ renal ven kısa olduğu için ostium ve renokaval devamlılık özellikle izlenmelidir.
• Koronal ve sagittal reformasyonlarda trombüsün kraniyal ucu, hepatik venler, diyafram ve sağ atriyumla ilişkisi belirlenir.
• Renal ven veya VCI içindeki tümör trombüsü genellikle primer kitleye benzer kontrastlanma gösterirken, basit trombüs tipik olarak kontrastlanmaz.
• Damar duvarı düzensizliği, çevre yağ planına uzanım veya lümenin sabit daralması venöz duvar invazyonu şüphesini artırır.

Ölçütler ve sınıflamalar

Mayo I düzeyi için renal ven ostiumunun üzerindeki uzanım

≤2 cm

Mayo II düzeyi için renal ven ostiumunun üzerindeki uzanım

>2 cm; hepatik venlerin altında

Mayo tümör trombüsü düzeyleri

Düzey I: diyafram altı VCI’ye uzanır ve renal ven ostiumunun 2 cm içinde kalır. Düzey II: ostiumun 2 cm’den fazla kraniyaline uzanır ancak hepatik venlerin birleşiminin altında kalır. Düzey III: hepatik venlerin birleşiminin üstündeki, diyafram altı VCI’ye uzanır. Düzey IV: diyafram üstüne uzanır ve sağ atriyumu içerebilir.

Normalde

Karşı renal venle ve aynı tarafın arteriyel/portal faz görüntüleriyle kıyaslayarak lümen içindeki dokunun kitleyle devamlılığını, damar genişlemesini ve VCI içindeki kraniyal sınırını belirleyin.

Ayırıcı tanı

Basit venöz trombüs genellikle kontrastlanmaz; tümör trombüsü ise primer kitleye benzer kontrastlanma gösterebilir.

Renal ven invazyonu yapan başka tümör

böbrek kitlesiyle birliktelik ve tümörün kontrastlanma paterni primer odağa göre yorumlanır.

Akım artefaktı veya karışım etkisi

çoğunlukla VCI'de kontrastın tam karışmadığı kesitlerde görülür ve komşu fazlarda ya da ardışık kesitlerde sabit bir kitle gibi sürmez.

Tuzaklar

• Renal venler düzeyinde kontrastlı ve kontrastlanmamış kanın karışımı VCI'de yalancı dolum kusuru oluşturabilir; çok düzlemli reformasyonlar değerlendirmeye yardımcı olur.
• Trombüsün tepe noktası aksiyel tek kesitte damar kıvrımıyla üst üste gelebilir; koronal ve sagittal reformasyonla gerçek kraniyal uzanımı gösterin.
• Basit trombüs genellikle ven duvarının sınırlarını aşmaz; tümör trombüsü ise çevre venöz dokulara uzanabilir.

Kendini dene

1. Renal kitleyle aynı şekilde kontrastlanan doku renal veni genişletip VCI'ye uzanıyor. En olası tanı?

   • Tümör trombüsü
   • Bland trombüs
   • Renal ven basısı
   • Parapelvik kist
   Cevabı göster

   Tümör trombüsü. Kitleyle devamlı ve benzer kontrastlanan damar içi doku tümör trombüsünü destekler. Bland trombüs tipik olarak kontrastlanmaz; basıda lümen dıştan daralır, parapelvik kist ise damar lümeninde bulunmaz.

2. VCI'de kontrastlanmayan kaudal dolum kusuru, üstte kontrastlanan renal ven tümör uzanımıyla birlikte. Kaudal bileşen nedir?

   • Bland trombüs
   • Tümör trombüsü
   • Lenfanjiektazi
   • Kaliks divertikülü
   Cevabı göster

   Bland trombüs. Kontrastlanmayan kaudal bileşen bland trombüsle uyumludur ve tümör trombüsüne eşlik edebilir. Tümör dokusu kontrastlanma gösterir; lenfatik koleksiyon ve kaliks divertikülü damar içi dolum kusuru oluşturmaz.

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 5 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Tumor in the veins: an abdominal perspective with an emphasis on CT and MR imagingpmc.ncbi.nlm.nih.gov
2. CD70-Targeted Immuno-PET/CT Imaging of Clear Cell Renal Cell Carcinoma: A Translational Study.pubmed.ncbi.nlm.nih.gov
3. Imaging and implications of tumor thrombus in abdominal malignancies: reviewing the basics.pubmed.ncbi.nlm.nih.gov
4. A Normal FGF23 Does Not Preclude Tumor-Induced Osteomalacia.pubmed.ncbi.nlm.nih.gov
5. A renal angiomyolipoma with a challenging presentation: a case report.pubmed.ncbi.nlm.nih.gov
6. Surgical Tips for Inferior Vena Cava Thrombectomy.pubmed.ncbi.nlm.nih.gov
7. Clinical versus Pathologic staging of Renal Tumors: Role of Multi-Detector CT Urography.pubmed.ncbi.nlm.nih.gov
8. Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging.pubmed.ncbi.nlm.nih.gov
9. Wilms tumor: Successes and challenges in management outside of cooperative clinical trials.pubmed.ncbi.nlm.nih.gov
10. [Epithelioid Angiomyolipoma of the Kidney: A Case Report].pubmed.ncbi.nlm.nih.gov
11. 2-[ 18 F]FDG PET/CT parameters associated with WHO/ISUP grade in clear cell renal cell carcinoma.pubmed.ncbi.nlm.nih.gov
12. Secondary pelvic congestion syndrome: description and radiographic diagnosis.pubmed.ncbi.nlm.nih.gov
13. 'Full prosthetic jacket': external stenting of the renal vein.pubmed.ncbi.nlm.nih.gov
14. Central neurogenic hyperventilation secondary to suspected metastatic renal cell carcinoma.pubmed.ncbi.nlm.nih.gov
15. How to assess the efficacy or failure of targeted therapy: Deciding when to stop sorafenib in hepatocellular carcinoma.pubmed.ncbi.nlm.nih.gov
16. Giant Clear Cell Renal Cell Carcinoma With Continuous Tumor Thrombus Extension Into the Left Renal, Gonadal, Ascending Lumbar, and Hemiazygos Veins: A Case Report.pubmed.ncbi.nlm.nih.gov
17. The Silent Giant: Asymptomatic Renal Cell Carcinoma With a Level III Inferior Vena Cava Thrombus.pubmed.ncbi.nlm.nih.gov
18. Primary Renal Ewing Sarcoma Presenting With Divergent Radiological Phenotypes: A Radiology-Focused Case Series Featuring the Mimicking of Renal Cell Carcinoma and Urinary Tract Urothelial Carcinoma.pubmed.ncbi.nlm.nih.gov
19. The Central Role of Imaging in Renal Cell Carcinoma: A Comprehensive Review of Tumor Aggressiveness, Histology, and Radiomics.pubmed.ncbi.nlm.nih.gov
20. Open Surgical Management of Renal Cell Carcinoma with Infradiaphragmatic Venous Tumor Thrombus (Mayo Levels 0-III): The Epitome of Surgical Self-Reliance in Urology.pubmed.ncbi.nlm.nih.gov
21. Multiphase CT-derived markers for the characterization of large solid and cystic renal masses by histology and grade.pubmed.ncbi.nlm.nih.gov
22. Venous Tumor Thrombus Level in Renal Cell Carcinoma: Impact on Surgical and Oncologic Outcomes.pubmed.ncbi.nlm.nih.gov
23. Preoperative MRI Model for Predicting Inferior Vena Cava Wall Invasion in Renal Cell Carcinoma with Tumor Thrombus.pubmed.ncbi.nlm.nih.gov
24. When Cancer Clots: An Extensive Radiologic Analysis of Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
25. Can Artificial Intelligence Really Help? A Practicing Radiologist's Simplified Guide to AI, with a Critical Appraisal of the Use of AI in Cancer-Associated Thromboembolism.pubmed.ncbi.nlm.nih.gov
26. Long-term follow-up monitoring with multimodal ultrasound in a case of suspected renal angiomyolipoma with renal vein/inferior vena cava thrombus: a case report.pubmed.ncbi.nlm.nih.gov
27. Case review: adult epithelial type Wilms tumor in a 23-year-old female.pubmed.ncbi.nlm.nih.gov
28. Value of Multimodality Imaging in the Early Diagnosis of Intravascular and Intracardiac Leiomyomatosis.pubmed.ncbi.nlm.nih.gov
29. MR Lymphangiography in Pediatrics: Indications, Technique, Findings, and Management.pubmed.ncbi.nlm.nih.gov
30. Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives.pubmed.ncbi.nlm.nih.gov
31. Multiphasic CT-based multimodal deep learning model for predicting early hepatocellular carcinoma recurrence following liver transplantation.pubmed.ncbi.nlm.nih.gov
32. A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus.pubmed.ncbi.nlm.nih.gov
33. Inferior vena cava tumor thrombus: clinical outcomes at a canadian tertiary center.pubmed.ncbi.nlm.nih.gov
34. Radical nephrectomy with inferior vena cava tumor thrombectomy in Mayo III-IV renal cell carcinoma: a retrospective single-center study.pubmed.ncbi.nlm.nih.gov
35. Malignant Venous Obstruction: Superior Vena Cava Syndrome and Beyond.pubmed.ncbi.nlm.nih.gov
36. Imaging in Vascular Liver Diseases.pubmed.ncbi.nlm.nih.gov
37. Emphysematous conditions of the abdomen and pelvis: pearls and pitfalls.pubmed.ncbi.nlm.nih.gov
38. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings.pubmed.ncbi.nlm.nih.gov
39. Long-term safety and effectiveness of the "OptEase" vena cava filter.pubmed.ncbi.nlm.nih.gov
40. Case Report: En bloc resection of inferior vena cava and renal cell carcinoma with level IV tumor thrombus associated with tumor thrombus embolization to the pulmonary arteries: presence of blood vessels inside the tumor thrombus.pubmed.ncbi.nlm.nih.gov
41. Efficacy and safety of neoadjuvant therapy with tislelizumab plus axitinib for nonmetastatic renal cell carcinoma with inferior vena cava tumor thrombus: a retrospective study.pubmed.ncbi.nlm.nih.gov
42. The Significant Role of Tumor Volume on the Surgical Approach Choice, Surgical Complexity, and Postoperative Complications in Renal Cell Carcinoma With Venous Tumor Thrombus From a Large Chinese Center Experience.pubmed.ncbi.nlm.nih.gov
43. Spontaneous bacteremia and spontaneous bacterial peritonitis share similar prognosis in patients with cirrhosis: a cohort study.pubmed.ncbi.nlm.nih.gov
44. Commentary: an eye on PET quantification.pubmed.ncbi.nlm.nih.gov
45. Pathophysiological management of gastric varices: From hemodynamics to targeted therapies.pubmed.ncbi.nlm.nih.gov
46. From congenital variants to critical clues: A radiologic review of inferior vena cava pathologies.pubmed.ncbi.nlm.nih.gov
47. Postpartum ovarian vein thrombosis: plain CT with clinical indicators-diagnostic performance and clinical application.pubmed.ncbi.nlm.nih.gov
48. Stereotactic body radiation therapy in patients with unresectable hepatocellular carcinoma and portal vein tumor thrombosis.pubmed.ncbi.nlm.nih.gov
49. Neoadjuvant Toripalimab Plus Axitinib for Nonmetastatic Clear Cell Renal Cell Carcinoma With Tumor Thrombus: A Combined Analysis of Two Phase II Clinical Trials.pubmed.ncbi.nlm.nih.gov
50. Surgical management of renal cell carcinoma with extension into the inferior vena cava and right atrium: A case report.pubmed.ncbi.nlm.nih.gov
51. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
52. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
53. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
54. Multiomics Analysis-Based Biomarkers in Diagnosis of Polycystic Ovary Syndrome.pubmed.ncbi.nlm.nih.gov
55. High-affinity alphavbeta3 integrin targeted optical probe as a new imaging biomarker for early atherosclerosis: initial studies in Watanabe rabbits.pubmed.ncbi.nlm.nih.gov
56. Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.pubmed.ncbi.nlm.nih.gov
57. Interventional Management of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus and Secondary Deep Venous Thrombosis: A Case Report.pubmed.ncbi.nlm.nih.gov
58. Case Report: Upper extremity deep vein thrombosis revealing an occult invasive ductal breast carcinoma.pubmed.ncbi.nlm.nih.gov
59. Trousseau syndrome: management of refractory VTE.pubmed.ncbi.nlm.nih.gov
60. Coagulation Abnormalities in Liver Cirrhosis: Diagnostic and Therapeutic Approaches.pubmed.ncbi.nlm.nih.gov
61. Organ-Confined Giant Renal Cell Carcinoma: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
62. Neoadjuvant lenvatinib and pembrolizumab for metastatic clear cell renal cell carcinoma: A potential opportunity for complete pathologic and radiographic response.pubmed.ncbi.nlm.nih.gov
63. Curative-Intent Pancreatectomy for Pancreatic Metastasis From Renal Cell Carcinoma 30 Years After Nephrectomy Following Lenvatinib Plus Pembrolizumab Therapy: A Case Report.pubmed.ncbi.nlm.nih.gov
64. 2.5-mm articulated endoluminal forceps using a compliant mechanism.pubmed.ncbi.nlm.nih.gov
65. Renal Angiomyolipoma with Tumor Thrombus in the Inferior Vena Cava and Right Atrium Accompanied by Renal Cell Carcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
66. Cystic lesions and their mimics involving the intrahepatic bile ducts and peribiliary space: diagnosis, complications, and management.pubmed.ncbi.nlm.nih.gov
67. Soft tissue pseudotumours: a pictorial review with emphasis on MRI.pubmed.ncbi.nlm.nih.gov
68. Robotic surgical techniques and methods for treating renal cell carcinoma with inferior vena cava tumor thrombus.pubmed.ncbi.nlm.nih.gov
69. Guidance for clinical practice using emergency and point-of-care ultrasonography.pubmed.ncbi.nlm.nih.gov
70. Ipsilateral adrenal metastasis with adrenal and residual renal vein tumor thrombus from ESC-RCC 6 years post-nephrectomy: A case report.pubmed.ncbi.nlm.nih.gov
71. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review.pubmed.ncbi.nlm.nih.gov
72. Contemporary Clinical Definitions, Differential Diagnosis, and Novel Predictive Tools for Renal Cell Carcinoma.pubmed.ncbi.nlm.nih.gov
73. Pathological Complete Response to Nivolumab Plus Ipilimumab Combination Therapy in Advanced Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus.pubmed.ncbi.nlm.nih.gov
74. Primary Renal Mesenchymal Tumors: A Study from North India, Emphasizing Rare Entities and Molecular Profiles.pubmed.ncbi.nlm.nih.gov
75. Complicated renal angiomyolipoma with renal vein fat embolism mimicking lipid-rich renal cell carcinoma: A case report.pubmed.ncbi.nlm.nih.gov
76. Spinal venous hypertension secondary to nutcracker syndrome-a previously unreported cause of congestive myelopathy.pubmed.ncbi.nlm.nih.gov
77. Superior Mesenteric Artery Syndrome Complicated by Nutcracker Syndrome: Diagnostic and Therapeutic Challenges.pubmed.ncbi.nlm.nih.gov
78. Recurrent transplant renal vein thrombosis caused by May-Thurner syndrome: a case report and review of literature.pubmed.ncbi.nlm.nih.gov
79. Massive Inferior Vena Cava Thrombosis and Pulmonary Embolism Secondary to Hepatic Hydatid Cyst: A Fatal Case.pubmed.ncbi.nlm.nih.gov
80. Heavily ossified renal mass as the initial presentation of primary renal osteosarcoma: a case report.pubmed.ncbi.nlm.nih.gov
81. Arterial tortuosity syndrome presenting as severe precapillary pulmonary hypertension in adulthood.pubmed.ncbi.nlm.nih.gov
82. Radiographic overestimation of inferior vena cava involvement in pediatric neuroblastoma: a case report.pubmed.ncbi.nlm.nih.gov
83. Mediastinal Pancreatic Pseudocyst With Esophageal Compression Presenting as Acute Chest Pain.pubmed.ncbi.nlm.nih.gov
84. Aneurysmal Circumaortic Left Renal Vein: A Rare Anatomical Variant Managed With Open Surgery.pubmed.ncbi.nlm.nih.gov
85. Endovenous reconstruction of congenital iliocaval anomalies.pubmed.ncbi.nlm.nih.gov
86. Kidney and inferior vena cava abnormalities with leg thrombosis (KILT) syndrome presenting as extensive iliofemoral deep vein thrombosis in a young patient.pubmed.ncbi.nlm.nih.gov
87. Intraoperative Echocardiography as a Cornerstone in Anesthetic Care for Mayo Level IV Clear Cell Renal Cell Carcinoma with Cavoatrial Invasion in a Patient with Sickle Cell Trait.pubmed.ncbi.nlm.nih.gov
88. Surgical strategy and outcomes in renal cell carcinoma with inferior vena cava tumor extension: A tertiary center experience.pubmed.ncbi.nlm.nih.gov
89. Diagnostic Accuracy of Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Differentiating Tumor and Bland Thrombus in Patients With Cancer: A Systematic Review and Meta-Analysis.pubmed.ncbi.nlm.nih.gov
90. Metastatic Retroperitoneal Rhabdomyosarcoma in a Child: A Case Report Highlighting the Role of Imaging in Diagnosis, Staging, and Follow-Up.pubmed.ncbi.nlm.nih.gov
91. Extranodal Rosai-Dorfman disease with bilateral renal involvement: A diagnostic challenge.pubmed.ncbi.nlm.nih.gov
92. The Initial Diagnostic Approach to Adult Congenital Heart Disease: A Practical Imaging Pathway for General Cardiologists and Cardiac Imagers.pubmed.ncbi.nlm.nih.gov
93. In Situ Pulmonary Artery Thrombosis and Low Flow Stasis Artifact in Parenchymal Lung Disease: An Under-Recognized Phenomenon.pubmed.ncbi.nlm.nih.gov
94. Anticoagulant outcomes in managing tumor thrombus: a systematic review.pubmed.ncbi.nlm.nih.gov
95. Multimodal Interdisciplinary Management of Level III Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus: The Role of Preoperative Embolization, Intracaval Balloon Control, and Radical Nephrectomy With Inferior Vena Cava Thrombectomy.pubmed.ncbi.nlm.nih.gov
96. Inferior vena cava hyperechoic structure in a patient with cardiac myxoma: a surgical case report and literature review.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez. İçerik yapay zekâ destekli bir süreçle güncel literatüre göre cümle cümle kaynaklarla karşılaştırıldı, ancak uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.