Renal infarction

Case contributed by A.Prof Frank Gaillard

Presentation

Hit by car while riding bike in the country side. Imaged at the local hospital and transferred to tertiary hospital . Ongoing right loin / flank pain with blood in the urine.

Patient Data

Age: 18 years
Gender: Female
CT

The right kidney is non enhancing, apart from a small region of enhancing renal parenchyma in the inferior pole, is swollen and surrounded by stranding. The right renal artery is transected, with no contrast extravasation from its stump to suggest active bleeding.  There is a very small right accessory renal artery, arising from the abdominal aorta superior to the origin of the right renal artery, which opacifies with contrast and appears to supply the viable renal tissue.  

No convincing pseudoaneurysm detected. Tiny punctate density (on the portal venous phase) adjacent to the inferior aspect of the hilum is of uncertain significance.  This may represent a tiny intraparenchymal pseudoaneurysm or a small vein.  Variant venous anatomy is demonstrated, with a vein draining the right posterolateral abdominal wall communicating with the right renal vein.

Small retroperitoneal haematoma, at the inferior margin of the right kidney, is present.  There is a small amount of blood adjacent to the posterior margin of the spleen, marginally increased in volume compared to the previous study.  Stable amount of free fluid in the pelvis.  No free intra-abdominal gas is detected.  Small locules of subcutaneous gas are present in the left anterior abdominal wall.

The left renal collecting system and bladder contain contrast on the non-contrast phase, consistent with recent contrast administration.  The left kidney is unremarkable.  The bladder is predominantly collapsed around an indwelling catheter with its balloon inflated.  Gas within the bladder is consistent with recent instrumentation.  

Subcapsular hypodensity in the liver adjacent to ligamentum teres without local mass effect on adjacent parenchyma is consistent with focal fatty sparing.  The pancreas, spleen and adrenal glands are unremarkable.  No dilated loops of bowel or evidence of mechanical bowel obstruction.  There is mild faecal loading and minor faecalisation of small bowel.  

Annotated image

Non enhancing right kidney (blue dotted line) with a only a short stump of the right renal artery visible (red arrow). A small amount of tissue at the inferior pole of the kidney demonstrates some enhancement, as a result of it being supplied by a very small accessory branch (yellow arrow) arising either form the aorta, or proximal renal artery, prior to occlusion. 

The combination of this small accessort artery and some capsular supply (not visualised) contributes to contrast opacification of the right renal vein (orange arrow). 

Case Discussion

This patient remained stable, requiring only analgesia and made an uneventful recovery. 

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Case information

rID: 18891
Case created: 26th Jul 2012
Last edited: 29th Nov 2016
System: Urogenital
Inclusion in quiz mode: Included

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