Traumatic renal artery dissection

Case contributed by Dr Bruno Di Muzio

Presentation

MVA at 90km/h (driver, with seat belt).

Patient Data

Age: 20 years
Gender: Male

CT Abdomen and pelvis

CT

Lack of enhancement of the renal parenchyma involving the upper and part of mid third of the left kidney in keeping with an acute infarct. The renal pelvis and ureter are preserved on the contrast and delayed phase (no urine leak visible). No perirenal fat-stranding. No evidence of vascular active bleeding. 

Small amount of fluid tracking along the anterior left pararenal space and also observed in the pelvis, showing high attenuation in keeping with hematoma component. 

The spleen shows a moderate sized central and inferior laceration and associated with a small amount of subcapsular hematoma. Mild retroperitoneal fat stranding with some prominent lymph nodes. 

Liver, pancreas, right kidney and adrenal glands are normal. No abnormality of the bowel is identified. There is no free gas. 

Angiography

DSA (angiography)

A left renal angiogram demonstrates 2 left renal arteries. The more superior (the major renal artery) has evidence of a dissection with occlusion of the posterior segmental branch. A small accessory lower pole renal artery is of normal appearance.

Images courtesy from the radiology interventional team from the Royal Melbourne Hospital.

Case Discussion

Traumatic left renal artery dissection causing an acute infarct in the left kidney upper moiety. 

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