鄭詠庭¹，陳育青²，高銘鴻¹，蒲永孝¹，姜宜妮¹

¹國立台灣大學附設醫院 泌尿部，²國立台灣大學附設醫院 影像醫學部

Yung-Ting Cheng¹, Yu-Chin Chen², Ming-Hong Kao¹, Yeong-Shiau Pu¹, I-Ni Chiang¹*

¹Department of Urology, National Taiwan University Hospital, ²Department of Radiology, National Taiwan University Hospital

 

Background: Gross hematuria of unknown etiology in young adults offer a challenging scenario in clinical diagnosis. Vascular abnormalities are one of the rare causes which should be considered in suspected upper urinary tract origin. Pelvic congestion syndrome and renal pelvic varices were venous abnormalities caused by venous obstruction or abnormal valves. We described an extremely rare case of a 33-year-old female with renal peripelvic varices and pelvic congestion syndrome who presented with massive hematuria.

Summary: A 33-year-old female presented with a history of intermittent painless gross hematuria for 3 months. There was no history of smoking, herbs, toxins, trauma or bleeding disorders. Her biochemical and coagulation parameters were within normal limits. Sonography showed a huge mass over the bladder without bilateral hydronephrosis. Cystoscopy revealed negative finding. Computed tomography(CT) demonstrated negative finding other than blood clot. However, continuous massive hematuria progressed to hypovolemic shock. Emergent endovascular embolization was performed after resuscitation. Angiogram revealed no definite arterial anomaly. Venography showed engorged left ovarian veins with peripelvic varices. The aberrant veins emerged from the renal hilum and then drained into the left renal vein and common iliac vein. Left lower ovarian veins and peripelvic varices were subsequently embolized by pushable coils. The patient discharged without hematuria afterwards.

Conclusion: Venous etiology should be included for the differential diagnosis of hematuria of unknown origin, which may cause life-threatening massive hematuria. Endovascular treatment can achieve optimal result.