Case Author(s): Sarah Reimer, MD and Keith Fischer, MD , 4/16/99 . Rating: #D2, #Q4
Diagnosis: renal infarction
Brief history:
This 40-year-old man experienced sudden onset of flank pain while sitting at his desk.
Images:
Radionuclide angiogram from a renal scintigram
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View second image(rs).
Functional images from a renal scintigram
View third image(ct).
Axial contrast-enhanced CT.
View fourth image(an).
Selective right renal artery injection.
Full history/Diagnosis is available below
Diagnosis: renal infarction
Full history:
Forty-year-old male with no significant past medical history presented with sudden onset of right flank pain while sitting at his desk.
Radiopharmaceutical:
Tc-99m MAG3 i.v.
Findings:
There is no perfusion to the lateral portion of the upper pole of the right kidney on the radionuclide angiogram. No tracer accumulates in this region on the functional images.
On the CT there is no contrast enhancement of this area.
Selective injection of the right renal artery demonstrates the classic string of beads appearance of the vessel to the upper pole. The tapered narrowing of dissection is seen distal to this.
Discussion:
The angiographic findings are most consistent with fibromuscular dysplasia. Fibromuscular dysplasia (FMD) is a proliferation of muscular and fibrous elements in medium and large sized artereries. The renal arteries are most frequently involved, followed by the internal carotid and vertebral arteries. This is an example of the most common type of FMD, which involves the media and causes alternating stenoses and aneurysms. Five to ten percent of renal artery FMD may be complicated by spontaneous dissection, as occured in this case. Other potential complications include aneurysm rupture and embolization. Renal FMD is very responsive to PTA.
Followup:
Patch angioplasty was performed.
ACR Codes and Keywords:
References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Misc)
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Case number: rs021
Copyright by Wash U MO
