Case Author(s): Jeff Chesnut, D.O. and Jerold Wallis, M.D. , 5/22/99 . Rating: #D1, #Q4

Diagnosis: Subcapsular renal hematoma resulting in markedly diminished perfusion

Brief history:

18 year old pregnant female who was run over by a car.

Images:

Radionuclide angiogram of the kidneys are shown.

View main image(rs) in a separate image viewer

View second image(rs). Posterior function images of the kidneys are shown.

View third image(rs). Single posterior function images of the kidneys are shown (increased intensity).

Full history/Diagnosis is available below


Diagnosis: Subcapsular renal hematoma resulting in markedly diminished perfusion

Full history:

18 year old pregnant female who was run over by a car. Abdominal ultrasound demonstrated a right subcapsular renal hematoma causing deformation of the right kidney with some associated retroperitoneal blood and ascites. Doppler wave forms were markedly blunted in the right renal artery.

Radiopharmaceutical:

Tc-99m MAG3

Findings:

There is minimal flow to the right kidney with prompt perfusion of the left kidney. The left kidney is of normal size and morphology. The right kidney has only minimal uptake, and additionally demonstrates an area of absent perfusion in the lateral portion of the mid-kidney. There is prompt uptake and excretion by the left kidney.

Discussion:

Renal scintigraphy is a very sensitive modality for for the evaluation of renal blood flow and renal function. When perfusion is markedly diminished, visualization will be best on the delayed images (if there is uptake, then some perfusion must be present). Markedly diminished renal perfusion may result from extra-capsular vascular problems or from increased intracapsular pressure as can be seen with hematoma and swelling.

Followup:

The patient's right flank discomfort gradually improved. Subsequent ultrasounds demonstrated liquefaction of the subcapsular hematoma with improvement in the Doppler wave forms. It remains to be seen how much function will return to the right kidney.

ACR Codes and Keywords:

References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Effect of Trauma)

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Case number: rs022

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