Pulmonary Embolism in Autosomal Dominant Polycystic Kidney Patient Induced by Inferior Vena Cava Mechanical Compression
  • Maamoun Basheer
    Internal Medicine Department, Galilee Medical Center, Nahariya, Israel
  • Elias Saad
    Internal Medicine Department, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safad, Israel
  • Assy Nimer
    Internal Medicine Department, Galilee Medical Center, Nahariya, Israel; Faculty of Medicine in the Galilee, Bar-Ilan University, Safad, Israel

Keywords

Autosomal dominant polycystic kidney disease, renal cyst, inferior vena cava, pulmonary embolism

Abstract

Introduction: Autosomal dominant polycystic kidney disease is a common syndrome. Renal and hepatic cysts can cause discomfort, bleeding, rupture, infection, hypertension and a mass effect with compression of adjacent organs.

Case presentation: A 48-year-old man with polycystic kidney disease and hypertension presented to the emergency department for bilateral flank pain. An abdominal computed tomography scan with contrast showed a 7 cm heterogeneous process posteriorly and laterally to the right kidney. It appeared to be a renal cyst associated with bleeding and bilateral pulmonary artery filling defects, apparently due to  pulmonary embolism. Cavography following inferior vena cava filter insertion did not show any deep vein thrombosis.

Discussion and conclusion: The pulmonary embolism was probably caused by extrinsic inferior vena cava compression by a liver cyst. Virchow's triad of stasis, vessel damage and hypercoagulability probably resulted in a thrombus which moved on the right side to the pulmonary artery.

VIEW THE ENTIRE ARTICLE

References

  • Davies F, Coles GA, Harper PS, Williams AJ, Evans C, Cochlin D. Polycystic kidney disease re-evaluated: a population-based study. Q J Med 1991;79:477–485.
  • Gabow PA. Autosomal dominant polycystic kidney disease. N Engl J Med 1993;329:332–342.
  • Levy M, Feingold J. Estimating prevalence in single-gene kidney diseases. progressing to renal failure. Kidney Int 2000;58:925–943.
  • Torres VE, Harris PC, Pirson Y. Autosomal dominant polycystic kidney disease. Lancet 2007;369:1287–1301.
  • Higashihara E, Nutahara K, Kojima M, Tamakoshi A, Yoshiyuki O, Sakai H, et al. Prevalence and renal prognosis of diagnosed autosomal dominant polycystic kidney disease in Japan. Nephron 1998;80:421–427.
  • Tamburrini R, Ahmed Z, van der Walt J, Goldsmith D. Sudden death of a patient with polycystic kidneys due to acute inferior vena cava thrombosis. Scott Med J 2016;61(3):171–173.
  • Morimoto K, Akai Y, Matsui M, Yano H, Tagawa M, Samejima KI, et al. Acute pulmonary thromboembolism occurring during treatment with tolvaptan in a patient with autosomal-dominant polycystic kidney disease. CEN Case Rep 2017;6(1):61–65.
  • Holzmann-Littig C, Lorenz G, Wen M, Heemann U, Renders L. A case of pulmonary embolism caused by compression of the vena cava by intra-abdominal masses in autosomal polycystic kidney disease. Clin Case Rep 2020;8(7):1149–1152.
  • O'Sullivan DA, Torres VE, Heit JA, Liggett S, King BF. Compression of the inferior vena cava by right renal cysts: an unusual cause of IVC and/or iliofemoral thrombosis with pulmonary embolism in autosomal dominant polycystic kidney disease. Clin Nephrol 1998;49(5):332–334.
  • Maeda T, Uchida Y, Oyamada K, Nakajima F. Thrombosis in inferior vena cava due to enlarged renal cysts in autosomal dominant polycystic kidney disease. Intern Med 2010;49:1891–1894.
  • Ko MK, Kim T, Lee WH, Park SH, Choi JH, Shin M, et al. Deep vein thrombosis due to compression of huge hepatic cyst successfully treated by inferior vena cava filter and cyst drainage. Korean J Gastroenterol 2018;72(3):146–149.
  • Peces R, Gil F, Costero O, Pobes A. Massive inferior vena cava thrombosis in a patient with autosomal dominant polycystic hepatorenal disease. Nefrologia 2002;22(1):75–78.
  • Iguchi S, Kasai A, Kishimoto H, Suzuki K, Ito S, Ogawa Y, et al. Thrombosis in inferior vena cava (IVC) due to intra-cystic hemorrhage into a hepatic local cyst with autosomal dominant polycystic kidney disease (ADPKD). Intern Med 2004;43(3):209–212.
  • Grantham JJ. The etiology, pathogenesis, and treatment of autosomal dominant polycystic kidney disease: recent advances. Am J Kidney Dis 1996;28(6):788–803.
  • Levine E, Grantham JJ. Perinephric hemorrhage in autosomal dominant polycystic kidney disease: CT and MR findings. J Comput Assist Tomogr 1987;11(1):108–111.
  • Gabow PA. Autosomal dominant polycystic kidney disease. N Engl J Med 1993;329(5):332–342.
  • Gabow PA, Duley I, Johnson AM. Clinical profiles of gross hematuria in autosomal dominant polycystic kidney disease. Am J Kidney Dis 1992;20(2):140–143.
  • Views: 649
    HTML downloads: 166
    PDF downloads: 263


    Published: 2021-08-25
    Issue: 2021: Vol 8 No 8 (view)


    How to cite:
    1.
    Basheer M, Saad E, Nimer A. Pulmonary Embolism in Autosomal Dominant Polycystic Kidney Patient Induced by Inferior Vena Cava Mechanical Compression . EJCRIM 2021;8 doi:10.12890/2021_002767.