PMC9362845_01
Imaging manifestations. (A) Coronal section of abdominal CT scan demonstrating compression of the right ureter with proximal ureteral dilatation and hydrops(red arrow). (B) Coronal section of abdominal CT scans howing a heterogeneous mass invading the inferior vena cava. (C) Inferior vena cava angiography revealing compression and narrowing of the inferior vena cava(red arrow). The main vessels were marked by arrows in other colors. RA, Right artery; IVC, inferior vena cava; AO, Aorta abdominalis.
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F1
Contrast-enhanced CT scans revealed a large (7.8 cm * 5.5 cm * 5.0 cm) irregular hypodense retroperitoneal mass with heterogeneous enhancement and invasion of the IVC, and the right ureter was compressed with proximal ureteral dilatation and hydrops (Figure 1A). CT of the IVC was performed to investigate the relationship between the tumor and the vessel. CT revealed that the IVC was encircled by the tumor with moderate invasion (Figure 1B). To further investigate whether the left and right renal veins had been invaded by the tumor, IVC angiography was suggested, revealing that the IVC was compressed and narrowed (Figure 1C).
Intra-operative view. (A) The view before the excision. (B) Reconstruction of the inferior vena cava with an artificial vascular graft. (C) Reimplantation of the left renal vein into the artificial vascular graft by interposition of the right renal vein. (D) Resection of the tumor carrying the kidney with ureter. The adjacent viscera and main vessels were marked by arrows. RV, Right vein; AO, Aorta abdominalis.
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F2
During the operation, we found that a 6 cm segment of the IVC, the right kidney with ureter, the descending duodenum seromuscular layer and the origin of the left renal vein had been invaded by the tumor (Figure 2A), therefore, the tumor was resected en bloc with the IVC (from the suprarenal to infrarenal segment), the right kidney with ureter, and the duodenum seromuscular layer. IVC reconstruction was performed with the interposition of a 20 mm diameter polytetrafluoroethylene (PTFE) prosthesis (Figure 2B). After the right renal vein was trimmed, it was anastomosed between the left renal vein and the reconstructed IVC (Figure 2C). Figure 2D showed the resection of tumor carrying the kidney with ureter.
The drawing of the procedure. RV, Right vein; IVC, inferior vena cava.
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F3
Since the procedure is a little complicated, Figure 3 showed the drawing of the procedure to visually describe the operation steps.