Kidney Week

Abstract: PUB299

Left (L) Renal Cell Carcinoma (RCC) with L Renal Vein Tumor Thrombus (TT) Presenting as New-Onset L Varicocele (LV): Missing Causative Imagery in English-Language Case Reports

Session Information

• Publication Only

Category: Onconephrology

• 1700 Onconephrology

Authors

• Veguilla Rivera, Nahomie Ivette, University of South Florida Morsani College of Medicine, Tampa, Florida, United States

Nahomie Ivette Veguilla Rivera, MD

• Durr, Jacques A., University of South Florida Morsani College of Medicine, Tampa, Florida, United States

Jacques A. Durr, MD

• Chaudhry, Umar, University of South Florida Morsani College of Medicine, Tampa, Florida, United States

Umar Chaudhry, MD

• Kessler, Benjamin, Tampa General Hospital, Tampa, Florida, United States

Benjamin Kessler, MD

• Bencosme, Eliana, University of South Florida Morsani College of Medicine, Tampa, Florida, United States

Eliana Bencosme, MD

Introduction

Although many medical students are taught in anatomy classes that new-onset LV may reflect impaired L renal vein drainage from L RCC, this dynamic link is often clinically overlooked: the L gonadal vein drains into the L renal vein, while the R gonadal vein drains into the IVC. Yet, remarkably, existing English-language case reports omit imaging of L renal vein obstruction—whether from TT or external compression by tumor—showing only a bulky renal mass that necessitates searching for verbal explanation in the case report to bridge the anatomical gap.

Case Description

A 42-year-old man presented with the triad of L flank pain, hematuria, and a palpable L abdominal mass. He reported new-onset LV. Upon directed questioning, he confirmed that it persisted in the recumbent position. Contrast-enhanced CT revealed a ~10 cm upper pole mass of the L kidney invading the sinus, with thrombus in the L renal vein extending from the hilum to the mid vein, displaying expansile morphology and heterogeneous enhancement—findings consistent with TT and confirmed by contrast-enhanced MRI. Scrotal Doppler ultrasound documented LV. Radical L nephrectomy confirmed RCC with a nonadherent renal vein TT (T3a N0 M0).

Discussion

We present a visual triptych:
(1) CT showing L RCC with renal vein TT;
(2) Anatomical drawing linking L renal vein obstruction to ipsilateral varicocele;
(3) Doppler ultrasound confirming LV.
Together, these three panels form an at-a-glance, nonverbal icon that bridges anatomy and clinical pattern recognition. This triptych directly addresses the lack of illustrative visuals in English-language case reports, despite the well-documented association between tumor-induced L renal vein outflow obstruction and LV. Though based on a single case, it evokes a déjà vu Gestalt—especially when considering older men with new-onset LV—and elevates visual pedagogy beyond words. Trainees often exclaim, “Ah ha! Of course!” upon viewing the image, underscoring its didactic clarity.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025188p0rbc