Contrast enhanced ultrasound for the diagnosis of bilateral renal lymphangiectasia: literature review and contrast enhan
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CASE REPORT
Contrast enhanced ultrasound for the diagnosis of bilateral renal lymphangiectasia: literature review and contrast enhanced ultrasound findings Simone Guadagni1 · Desirée Gianardi1 · Matteo Palmeri1 · Niccolò Furbetta1 · Gregorio Di Franco1 · Matteo Bianchini1 · Giulio Di Candio1 Received: 15 June 2020 / Accepted: 20 August 2020 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2020
Abstract Renal lymphangiectasia (RLmp) is a rare benign lymphatic malformation which should be distinguished from other more common pathologies. Ultrasound (US) examination can define the first diagnostic suspicion, but the definitive diagnosis is usually reached with a second level imaging such as computed tomography (CT) or magnetic resonance imaging (MRI). We herein describe for the first time in literature, the use of the contrast enhanced ultrasound (CEUS) in disclosing the nature of peri-renal anechoic lesions in a 27-years old woman, that were initially confused with parenchymal cysts at B-Mode US. The diagnosis of RLmp may be particularly demanding due to its rarity and different clinical presentations. We suggest a possible role of CEUS as a real time, cost saving and easily accessible second level diagnostic tool, that can represent an appealing alternative in the diagnostic work up of suspected RLmp, respect to other imaging modalities. Keywords Renal lymphangiectasia · Lymphatic malformation · CEUS
Introduction Renal lymphangiectasia (RLmp) is a rare entity characterized by dilated peri-renal and/or peri-pelvic lymphatics [1, 2]. It affects adults and children of both sexes and it can be bilateral or unilateral [3]. Except for some non-specific symptoms or unusual presentations, the majority of RLmp are asymptomatic and are incidentally detected by diagnostic imaging [4]. RLmp should be distinguished from other more common pathologies, particularly from polycystic kidney syndrome [5]. Thus, the knowledge of RLmp’s typical diagnostic pattern is fundamental to pose a correct diagnosis and to provide a suitable management of these patients. Due to the rarity of such disease, most information about RLmp in literature came from case reports. Ultrasound (US) examination can define the first diagnostic suspicion, but all authors agree that a second level imaging such as computed * Simone Guadagni s.guadagni@ao‑pisa.toscana.it 1
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
tomography (CT) or magnetic resonance imaging (MRI) is required for definitive diagnosis [6]. To the best of our knowledge, the use of contrast enhanced ultrasound (CEUS) for RLmp has not yet been reported. We herein describe the CEUS findings in a recent case of RLmp in which the high diagnostic yield of CEUS perfectly disclosed the nature of the peri-renal anechoic lesions that were initially confused with parenchymal cysts at B-Mode US.
Case presentation A 27-years old woman presented with recent history of
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