Spotted nephrograms - severe hypotension

Case contributed by Dr Chris O'Donnell

Presentation

Severe hypotension requiring adrenaline/noradrenaline infusion

Patient Data

Age: 65
Gender: Male
CT

CT to look for causes of sepsis or blood loss

Alternating dense nephrograms with wedge-shaped non-enhancement presumably due to vasoconstriction.

Case Discussion

Differential diagnosis for bilateral spotted nephrograms is bilateral pyelonephritis, tubular obstruction (esp. proteinaceous), ADPCKD and severe hypotension.  Multiple emboli should also be considered. 

Unilateral striation differential includes pyleonepritis, high grade ureteric obstruction, renal vein thrombosis and contusion.

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Case information

rID: 20301
Published: 11th Nov 2012
Last edited: 2nd Apr 2018
System: Urogenital
Inclusion in quiz mode: Included

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