Presentation
Emergency admission with abdominal pain and vomiting, with new diagnosis of atrial fibrillation. High lactate. Only significant backgrounf of arterial hypertension.
Patient Data
Complete devascularisation of the left kidney, showing swelling and mild perirenal inflammatory features.
Truncation of the mid segment of the single left renal artery, secondary to thrombotic material.
Small amount of free fluid in the abdomen and pelvis. The right kidney shows scarring and a well-defined low density wedge in the lower pole, secondary to further segmental infarct.
In the chest, the left atrial appendage is filled with thrombus. Heart size at the upper limits of normal with prominence of both atrial chambers.
Bilateral effusions are present, more substantial on the right side.
Case Discussion
Aside from the newly detected atrial fibrillation, an echocardiogram demonstrated moderate right and severe left ventricular systolic disfunctions.
Following consultation with urology, it was decided to leave the non-viable left kidney in situ. The glomerular filtration rate (GFR) dropped from >60ml/min prior to this episode to 38.
The patient was managed with therapeutic doses of subcutaneous heparin, followed by apixaban on discharge. Significant clinical improvement was achieved with medical management of heart failure and atrial fibrillation. Weeks after the event, the GFR was stationary ranging from 45-50ml/min.
Renal embolism is very often cardiogenic. This case underpins the role of radiology to actively seek the source of embolism to formulate a diagnosis and a therapy plan.
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