PMC5628569_01
Axial CT of the abdomen with contrast shows left hydronephrosis (star) and dilated left gonadal vein containing central thrombus (arrow) just proximal to the confluence with the left renal vein. Delayed left nephrogram progression indicates the presence of obstruction.
fig-1.jpg
PMC5628569_01_fig-1.jpg
f1
CT of the abdomen and pelvis showed distal descending colon diverticulitis, diminutive caliber IVC, and bilateral gonadal vein varices with acute GVT on the left side and associated hydroureteronephrosis (Fig. 1).
Coronal T1-weighted contrast-enhanced magnetic resonance image of the abdomen and pelvis reveals acute left gonadal vein thrombosis (star).
fig-2.jpg
PMC5628569_01_fig-2.jpg
f2
Magnetic resonance venography confirmed left gonadal vein occlusion with extension to the left common iliac vein with distal reconstitution of the left external and internal iliac veins (Fig. 2).
Left retrograde pyelogram showing left distal ureteral narrowing with proximal hydroureter.
fig-3.jpg
PMC5628569_01_fig-3.jpg
f3
There was clear narrowing of the distal left ureter with proximal lateral displacement, redundancy, and dilation (Fig. 3).
Cross-sectional CT of the pelvis immediately cephalad to the branching of the internal and external iliac veins before (A) and after (B) left ureteral stent (arrow) and left iliac vein stent placements.
fig-4.jpg
PMC5628569_01_fig-4.jpg
f4
CT 3 months later showed the indwelling ureteral stent and left common iliac vein stent with persistent bilateral varicose gonadal veins but also decreased inflammation, suggesting resolved thrombophlebitis (Fig. 4).