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Multiphase CT of the renal tract demonstrates an atrophic right kidney with a delayed nephrogram, with only the tip of the upper pole enhancing vividly. In contrast, the left kidney is normal in size, and enhances normally.
There is a proximal occlusion of the right renal artery, and the residual arterial supply to the right kidney is derived from small collateral branches. Background atheromatous change is present in the abdominal aorta.