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Usefulness of non-contrast-enhanced magnetic resonance venography in assessing Klippel-Trenaunay syndrome in an adult patient with renal insufficiency: a case description.

Klippel-Trenaunay syndrome (KTS) is a congenital vascular anomaly that usually presents in infancy. KTS is primarily diagnosed through clinical evaluation and confirmed by diagnostic imaging using Doppler ultrasound and crosssectional imaging modalities, such as contrast-enhanced computed tomography angiography (CTA) and magnetic resonance angiography (MRA) (1). KTS is rarely diagnosed in adults and can be more difficult to treat than in children due to the added complexity of comorbidities. One major feature of KTS is a venous malformation, which typically manifests as a distorted (varicose) vein on the surface of the swollen leg. The condition may be accompanied by significant bleeding, deep vein thrombosis (DVT), and embolic complications, leading to chronic stasis ulcers, venous insufficiency, and DVT. For patients with KTS who have persistent serious complications, active treatment, such as surgery or an imaging-guided intervention, may be necessary (2). Precision imaging diagnosis is therefore essential. Despite ultrasonography being the gold standard for evaluating unilateral leg swelling in clinical practice, it is not the optimal imaging modality for collateral veins and varices. Contrast-enhanced CTA and MRA can be used to image vessels in the entire lower extremity and are important for diagnosing vascular malformations. Noncontrast-enhanced MRA, which has been used to diagnose many diseases (3), may have potential as a diagnostic modality for vascular malformations. Herein, we report the case of a patient who presented with refractory DVT. With the help of MRA using a triggered non-contrast-enhanced technique, the underlying etiology of the patient’s KTS was detected. This paper also discusses the challenges in diagnosing rare vascular pathologies in adults with complex comorbidities and describes the clinical utility and advantages of non-contrastenhanced MRA.