腎細胞癌の下大静脈内腫瘍栓塞のX線診断学的検討

Abstract

Six cases of renal cell carcinoma with tumor thrombus extending into the inferior vena cava were radiologically reviewed. These cases were experienced at the Jikei University Hospital during three years period 1976 to 1978. On IVP 2 of6 (33%) had non-visualizing kidney. This incidence seems to be higher than over-all renal cell carcinoma. On renal arteriography, the striated vascular pattern coinciding with tumor thrombus could be seen on the late arterial to nephrographic phase. Non-visualization of the renal vein and visualization of collateral venous circulation on the venous phase were also diagnostic findings. Selective renal arteriography could demonstrate the striated vascular pattern in all 6 cases and aortography could in 3. On the venous phase, the renal vein could not be visualized in all 6 cases and reno-capsular, spermatic, adrenal and lumbar veins were visualized in 2. Inferior venacavography was most diagnostic demonstrating filling defect due to tumor thrombus in all 6 cases. In two cases having the inferior vena cava completely obstructed by tumor thrombus, abundant collateral circulation was demonstrated along the lumbar and vertebral veins. It is helpful for establishing mode of treatment to make clear tumor thrombus of the inferior vena sava by means of inferior venacavography and renal arteriography.