ABSTRACT

Objectives: The purpose of this study was to investigate the sources of bleeding from the lumen of the inferior vena cava (IVC) during removal of the tumor thrombus. We have studied the multidetector computed tomography (MDCT) anatomy of the posterior tributaries of the IVC, including variant lumbar veins and lumbar veins of the infrarenal IVC.

Materials and Methods: The retrospective study included 302 patients who underwent the bolus contrast-enhanced MDCT of the abdomen for various indications. We analyzed the anatomy of the variant lumbar veins and infrarenal IVC lumbar veins.

Results: Variant lumbar veins were detected in 50% of patients (151 out of 302). The diameter of these vessels ranged from 1 mm to 5 mm and averaged 2.5 mm. The distance from the upper edge of the right renal vein mouth to the variant vein mouth varied from 0 mm to 51 mm and averaged 13.7 mm. In 71% of cases the variant veins entered the subhepatic IVC. In 26.3% of cases it drained at the level of the upper edge of the renal vein mouths (cavarenal segment) and only in 2% of cases—to the retrohepatic IVC. Lumbar veins entered the IVC immediately next to the lower edge of the right renal vein mouth in 35 (11.6%) cases. Their average diameter was 4.7 mm. On the left side of the "risk zone" the lumbar veins drained only in 2 (0.7%) patients at a distance of 7 mm and 8 mm from the mouth of the left renal vein.

Conclusion: The variant lumbar veins rarely are the main source of bleeding during thrombectomy. From our point of view, the right upper lumbar veins of the infrarenal IVC draining into the inferior vena cava in close proximity to the mouths of the renal veins played the leading role in this matter.

Dmytro V. Shchukin,^1,2 Oleksiy O. Altukhov,^1,2 Ganna V. Lisova,² Yuriy A. Ilyukhin³

¹V. I. Shapoval Regional Clinical Center of Urology and Nephrology, ²Kharkiv National Medical University, ³Belgorod Regional Clinical Hospital of Saint Joasaph

Submitted October 29, 2013 - Accepted for Publication December 13, 2013

KEYWORDS: Inferior vena cava, lumbar veins, variant lumbar vein, tumor thrombus, source of bleeding, MDCT

CORRESPONDENCE: Dmytro V. Shchukin, V. I. Shapoval Regional Clinical Center of Urology and Nephrology, 195, Moskovskyy Avenue, Kharkiv, 61037, Ukraine ()

CITATION: UroToday Int J. 2013 December;6(6):art 75]. http://dx.doi.org/10.3834/uij.1944-5784.2013.12.10

ABSTRACT

The penis is an uncommon site of metastasis, and about 300 cases have been reported worldwide. In order of frequency the primary sites of metastatic penile tumors are the urinary bladder (34.7%), prostate (29.8%), rectum and sigmoid colon (15.7%), and kidney (6.5%). Nearly 50 cases of penile metastasis with varied clinical features from rectal or sigmoid malignancy have been reported. Sagar et al. reported the second case of metastatic malignant melanoma secondary to the penis in 1992. Three and two-thirds of all penile metastasis are metachronus, and about 90% of the reported cases of penile metastasis are part of widespread disease.

We report a case of painful penile metastasis as a manifestation of malignant melanoma of the rectum, which was a disseminated disease.

Mufti Mahmood Ahmad, Iqbal Saleem, Asim Laharwal, Zahid Mohd Rather, Pervaz Ahmad, Waseem Raja, Irshad Ahmad lone, Sajad Parad

Government Medical College Srinagar, Jammu and Kashmir, Srinagar, India

Submitted September 20, 2013 - Accepted for Publication October 24, 2013 

KEYWORDS: Malignant melanoma, rectum, metastasis, priapism

CORRESPONDENCE: Mufti Mahmood Ahmad, M.Ch Urology, Government Medical College Srinagar, Jammu and Kashmir, Srinagar, India

CITATION: UroToday Int J. 2013 October;6(5):art 65. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.12