Images in Clinical Medicine
Floating Kidneys
N Engl J Med 2007; 356:1048March 8, 2007
- Article
A 48-year-old man with multiple myeloma and a history of a repaired umbilical hernia and four thromboembolic events was admitted for cramping abdominal pain associated with back pain and a weight loss of 5 kg (11 lb) during the previous month. Physical examination showed a distended abdomen and no lower-extremity edema. Laboratory evaluation was notable for a creatinine level of 1.2 mg per deciliter (108 μmol per liter), an albumin level of 3.3 g per deciliter, and normal urinary sediment. Contrast-enhanced computed tomography showed well-defined cystic retroperitoneal masses in which the kidneys appeared to be floating, extending from below the liver into the pelvis. Percutaneous drainage did not improve his symptoms. Flow cytometry of the fluid aspirated from a cyst showed no evidence of cystic lymphoma, and the cytologic findings were consistent with lymphangioma. Exploratory laparotomy revealed large, uncomplicated retroperitoneal cysts surrounding both kidneys. Total excision was not possible, because the walls of the cysts were adherent to the major abdominal vessels. Subsequently, the patient has had recurrent ascites requiring frequent percutaneous drainage in addition to medical therapy. Retroperitoneal cystic lymphangiomas are rare malformations of the lymphatic system. Complete surgical resection is the definitive treatment for symptomatic lymphangiomas. If resection is incomplete, recurrence is frequent, as in this case.
Patrick O. Myers, M.D.
Gilles Chassot, M.D.
Geneva University Hospital, Geneva, Switzerland
patrick.myers@hcuge. ch
