Sunday, April 15, 2012

An Unusual Cause of an Enhancing Retroperitoneal Mass


A40-year-old female presented with right flank pain. She had undergone placement of a Trapease (Cordis Corporation, Bridgewater, NJ) vena cava filter (VCF) 10 years before for multiple pulmonary emboli while taking birth control pills for uterine myomatous disease. Imaging demonstrated the presence of a 3.5-cm enhancing mass abutting the medial superior
pole of the right kidney and adjacent to the vena cava, at
the level of the VCF (Fig. 1).
 Figure 1. Computerized tomography showing contrast enhancing retroperitoneal mass juxtaposed to the right renal hilum (large arrow). Note most superior aspect of VCF positioned at the origin of the left renal vein (small arrow).

Percutaneous biopsy was
nondiagnostic; appropriate metabolic studies were unremarkable.
Open surgical exploration revealed a paracaval
venous mass adjacent to VCF tines eroding through the
wall of the vena cava. Etiology was likely multifactorial,
resulting from VCF erosion and location at the
renal veins, with compromised venous drainage leading
to venous hyperemia, stimulation of vascular growth factors,
and angiogenesis. Resection and reconstruction was
performed.
The patient recovered without sequelae. Follow-up
Duplex imaging confirmed the prosthetic grafts remained
patent at 30 days. Appropriate preoperative imaging
should recognize and help diagnose this rare complication.
1-3 This case represents the need for well-defined,
evidence-based guidelines for VCF insertion and followup.
4 Consultation with appropriate vascular specialists is critical, and we recommend an open approach to optimize
safety and reconstructive options.

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