Renal infarction - a secondary cause due to aortic dissection

Case contributed by Farris Al-Manaseer

Presentation

Patient with hypertension, tobacco use, and a recent dissection with repair a year prior who presented to the emergency department for evaluation of right flank pain.

Patient Data

Age: 45 years
Gender: Male

Emergency department chest X-ray revealed a widened mediastinum.

CT a dissection flap is seen involving the entire aorta forming a false lumen with active extravasation. In abdominal aorta, false lumen was supplying the infarcted right kidney. The dissection continued into the left common iliac artery.

The dissection also involves the right brachiocephalic artery and right common carotid artery.

Case Discussion

Our patient presented with right flank that has increased in severity over the recent weeks, but could not pinpoint an accurate timeline. He was reported to have generalized fatigue that continued to worsen over the most recent days. In addition, with his initial fatigue he had some nausea without any vomiting.

On initial evaluation, renal flank plain prompted evaluation of urolithiasis which revealed the previously noted dissection in patient's history. Upon investigation, we noted the active extravasation into a false lumen which appeared to support the right kidney. The pattern persisted into the left common iliac artery.

Normal renovascular anatomy suggests individual support for each renal system thus supporting the unilateral presentation. In addition, general flank pain and hypertension further support the leading cause of an aortic dissection.

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