[Inferior vena cava compression syndrome in cystic kidney. Duplex ultrasonic diagnosis]

Four months after renal transplantation for polycystic renal degeneration a 38-year-old man developed breathing-related pain in the left upper lung and a sinus tachycardia (130/min). Lung perfusion scintigraphy demonstrated pulmonary emboli from an acute venous thrombosis of the left lower leg. Polycythaemia and impairment of clot-inhibiting factors were excluded. Ultrasound examination of the abdomen revealed stenosis of the inferior vena cava (IVC) distal to the hepatic veins, dorsal to the liver and ventral of a huge right polycystic kidney which had been left in situ at the time of the renal transplantation. Duplex sonography demonstrated a band-like flow profile in the region of the stenosis. Blood flow was clearly increased (0.62 m/s) and not affected by either heart rate or breathing movements. The findings were confirmed by angiography. The right kidney, weighing 5 kg, was removed at surgery. The IVC stenosis was postoperatively found to be relieved and duplex sonography gave normal findings.