BACKGROUND:

A fatty tumor thrombus in the renal vein is rare and angiomyolipoma is the only benign tumor associated with it.

CLINICAL CASES:

Case 1: a 70-year-old woman presented with the incidental finding of a fatty tumor thrombus, during endocrine follow-up, in the left renal vein that extended into the vena cava, with no clearly associated kidney lesion. She was managed conservatively with anticoagulation and yearly control. Case 2: a 43-year-old woman was diagnosed during pregnancy with a mass in the right renal sinus, with a fatty thrombus in the renal vein and vena cava. Anticoagulation was begun and in the postpartum period, she underwent a right radical nephrectomy with thrombectomy. The anatomopathologic diagnosis was angiomyolipoma.

CONCLUSIONS:

A fatty tumor thrombus in the renal vein is rare and usually linked to a renal angiomyolipoma. Due to the risk for pulmonary embolism or malignant differentiation, radical nephrectomy with thrombectomy is the indicated treatment, even in asymptomatic patients. In the case of an isolated fatty thrombus in patients with comorbidities, conservative treatment is a valid option.

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