Professional paper

https://doi.org/10.57140/mj.55.3-4.9

Pyelovenous backflow caused by ureterolithiasis in combination with renal vein thrombosis detected by computed tomography – case report

Kristina Samaržija orcid.org/0009-0005-9146-3557 ; General hospital Karlovac, Department of radiology, Karlovac, Hrvatska
Ankica Pleša ; General hospital Karlovac, Department of radiology, Karlovac, Hrvatska
Vesna Ikač ; General hospital Karlovac, Department of radiology, Karlovac, Hrvatska
Jasminka Sušanj ; General hospital Karlovac, Department of urology, Karlovac, Croatia

Abstract

Pyelovenous backflow is the term for abnormal urinary flow from the renal collecting system to the renal vein. It is a rare condition resulting from a high pressure in the renal pelvis during the acute phase of urinary obstruction. The backflow is usually detected on retrograde pyelography. We present a case of a 78-year-old male, with a left upper pole calyceal-venous backflow, caused by acute ureteral obstruction by ureterolith, which was diagnosed by excretory phase of contrast-enhanced abdominal CT. The patient additionally had a thrombus in the left renal vein and inferior vena cava complicated by a pulmonary embolism of the lower right lobe. He was treated with high doses of low-molecular-weight heparin along with antibiotics and symptomatic therapy, without performing any surgical or interventional procedure on that kidney. After eight weeks, the ureterolith had descended from the level of the L3 vertebra to the level of the ureterovesical junction, and the pyelovenous backflow had disappeared, although the stone had still not been evacuated. To our knowledge, no case of pyelovenous backflow diagnosed by CT urography, which resolved without any medical intervention and without removing the cause of urinary obstruction, has been reported so far. We assume that during the descent of the stone through the ureter, the pressure in the renal pelvis decreased below the limit for pyelovenous backflow, and the pyelovenous backflow disappeared spontaneously. Contrast-enhanced CT can be an effective method in the diagnosis of pyelovenous backflow in the presence of a thrombus in the inferior vena cava, which slows the high venous flow sufficiently to allow visualization of contrast urine in the venous system. Due to the drainage of urine from the renal calyx, the pressure in the renal collecting system is reduced, so the symptoms of urinary obstruction can be mitigated and the diagnosis delayed.

Keywords

ureteral obstruction; hydronephrosis; pyelovenous backflow; multidetector computed tomography; venous thromboembolism

Hrčak ID:

342760

URI

https://hrcak.srce.hr/342760

Publication date:

8.1.2026.

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