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Aortic dissection or renal infarction--multislice computed tomographic angiography can tell
Milos Stojanović1, Slobodanka Pena-Karan, Biljana Joves-Sević
1Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia.
Srpski Arhiv Za Celokupno Lekarstvo
|January 8, 2013
Summary
Acute renal infarction, often missed due to vague symptoms, requires prompt diagnosis for kidney recovery. Multislice computed tomographic angiography accurately detects renal artery occlusion and infarction.
Area of Science:
- Nephrology
- Radiology
- Cardiology
Background:
- Acute renal infarction due to renal artery occlusion is frequently underdiagnosed because of non-specific clinical presentations.
- Timely diagnosis within three hours of symptom onset is critical for preserving renal function.
Observation:
- A 62-year-old male presented with sudden abdominal pain, right flank pain, nausea, diastolic hypertension, and a history of atrial fibrillation.
- Initial diagnosis considered aortic dissection, but multislice computed tomographic (MSCT) angiography revealed left renal artery thrombosis and infarction.
- Laboratory tests showed elevated lactate dehydrogenase (LDH) and serum creatinine.
Findings:
- MSCT angiography confirmed left renal artery thrombosis and infarction, characterized by an avascular area in the upper two-thirds of the left kidney.
- Both kidneys demonstrated contrast excretion.
- Follow-up CT after nine weeks indicated partial revascularization of the infarcted area.
Implications:
- The combination of flank pain, thromboembolism risk, and elevated LDH should raise suspicion for renal infarction.
- MSCT angiography is a valuable, non-invasive tool for diagnosing renal artery occlusion and infarction.
- Early detection and treatment, including anticoagulation, are vital for potential renal function recovery and revascularization.
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