Reversible Left Renal Vein Obstruction Caused by an Abdominal Aortic Aneurysm

Abstract

The authors document a unique cause for left renal vein hypertension and hematuria in a 66-year-old woman presenting with abdominal pain, pulsatile mass, and hematuria. A computer tomographic scan of the abdomen revealed, in association with a 5.3-cm fusiform abdominal aortic aneurysm, a compressed left renal vein as well as dilatation of the left gonadal vein and the pelvic venous plexus. Arteriography confirmed functional occlusion of the left renal vein by the juxtarenal enlargement of the abdominal aortic aneurysm. This created centrifugal flow to the inferior vena cava through the left gonadal vein, the pelvic venous plexus, and the hypogastric veins. The patient underwent abdominal aortic aneurysm repair with complete recovery. A postoperative abdominal computer tomographic scan confirmed restored patency of the left renal vein and normalization of centripetal venous flow on the left side. While a number of mechanisms of renal vein obstruction have been reported, collateralization and hematuria secondary to stretching and compression of the left renal vein by an aortic aneurysm have not previously been described. Although left renal vein hypertension and hematuria are rarely associated with an aortic aneurysm, it should be recognized that a juxtarenal aneurysm may cause this syndrome.