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.
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View second image(rs).
Posterior function images of the kidneys are shown.
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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
Copyright by Wash U MO
