Presentation
Patient with mixed septic and haemorrhagic shock.
Patient Data
Kidneys with reverse corticomedullary differentiation, non-enhancing cortex and a normal enhancing medulla (reverse rim sign) compatible with renal cortical necrosis. Portal venous gas. Bilateral adrenal gland hyperenhancement.
Colonic wall thickening is probably related to ischaemic colitis. Bilateral femoral haematomas with signs of active bleeding/false aneurysm on the left.
Small amount of free fluid in paracolic gutters. Mild bilateral pleural effusion.
Case Discussion
The patient was admitted to ICU for septic shock (possible foci: abdominal and dog bite) complicated with haemorrhagic shock of iatrogenic origin. Emergency femoral lines/punctures were performed. Haemodynamic instability with the need for noradrenaline and dobutamine and severe sepsis with PCT>100 developed.
The patient eventually died of multiorgan failure.
Renal cortical necrosis is a rare form of acute renal failure characterised by ischaemic destruction of all the elements of the renal cortex from significantly diminished renal arterial perfusion. In contrast-enhanced computed tomography it results in non-enhancement of the renal cortex in contrast to adequately enhancing renal medullae mimicking a retrograde renography. This CT finding (reverse rim sign) is diagnostic for renal cortical necrosis and usually results in permanent kidney injury.