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Pandey S, Aggarwal A, Kumar M, Sankhwar S. Spontaneous renal infarct heralding bowel ischaemia in an adult male: lessons to learn from a rare clinical association. BMJ Case Rep 2018. [PMID: 29525759 DOI: 10.1136/bcr-2017-223745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous renal artery dissection (SRAD) is a rare entity with less than 200 cases reported in literature. It usually affects middle-aged men and the clinical presentation is non-specific. Many times it is associated with conditions such as hypertension, fibromuscular dysplasia or vasculitides. We report the case of a patient who initially had renal infarct due to SRAD and then progressed to have bowel ischaemia. The renal infarct preceded bowel ischaemia in this patient and to the best of our knowledge this is the first such association reported in literature. Our report emphasises the point that whenever this condition is diagnosed in a patient one should be vigilant for other vascular disorders.
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Affiliation(s)
- Siddharth Pandey
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ajay Aggarwal
- Department of Urology, King George's Medical University, Lucknow, India
| | - Manoj Kumar
- Department of Urology, King George's Medical University, Lucknow, India
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Ahmed Z, Nabir S, Ahmed MN, Al Hilli S, Ravikumar V, Momin UZ. Renal Artery Injury Secondary to Blunt Abdominal Trauma - Two Case Reports. Pol J Radiol 2016; 81:572-577. [PMID: 28058071 PMCID: PMC5181523 DOI: 10.12659/pjr.899710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/03/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Blunt abdominal trauma is routinely encountered in the Emergency Department. It is one of the main causes of morbidity and mortality amongst the population below the age of 35 years worldwide. Renal artery injury secondary to blunt abdominal trauma however, is a rare occurrence. Here, we present two such cases, encountered in the emergency department sustaining polytrauma following motor vehicle accidents. CASE REPORT We hereby report two interesting cases of renal artery injury sustained in polytrauma patients. In these two cases we revealed almost the entire spectrum of findings that one would expect in renal arterial injuries. CONCLUSIONS Traumatic renal artery occlusion is a rare occurrence with devastating consequences if missed on imaging. Emergency radiologists need to be aware of the CT findings so as to accurately identify renal artery injury. This case report stresses the need for immediate CT assessment of polytrauma patients with suspected renal injury, leading to timely diagnosis and urgent surgical or endovascular intervention.
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Affiliation(s)
- Zahoor Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | | | - Shatha Al Hilli
- Department of Radiology, Hamad General Hospital, Doha, Qatar
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Renaud S, Leray-Moraguès H, Chenine L, Canaud L, Vernhet-Kovacsik H, Canaud B. Spontaneous renal artery dissection with renal infarction. Clin Kidney J 2015; 5:261-4. [PMID: 26069781 PMCID: PMC4400519 DOI: 10.1093/ckj/sfs047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 03/30/2012] [Indexed: 12/03/2022] Open
Abstract
Spontaneous renal artery dissection (SRAD) is a rare entity, which often presents diagnostic difficulties because of its non-specific clinical presentation. We report six cases complicated with renal infarction, occurring in middle-aged male patients without risk factors, illustrating the difficulty and delay for diagnosing SRAD. Ultrasound and Doppler imaging were not sensitive enough to confirm the diagnosis, and contrast-enhanced abdominal computed tomography was used to correct the diagnosis and allow the clinicians to propose appropriate treatment. We conclude that considering the urgency in diagnosing and treating SRAD, contrast enhanced abdominal tomography and/or abdominal magnetic resonance imaging should be proposed as soon as a suspicion of SRAD is evoked by the clinical presentation.
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Affiliation(s)
- Sophie Renaud
- Physiology Department, George Pompidou European Hospital, APHP, Paris, France
| | - Hélène Leray-Moraguès
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Leila Chenine
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Vascular and Radiology Department, Arnaud de Villeneuve Hospital, CHU Montpellier, Montpellier, France
| | - Bernard Canaud
- Nephrology, Dialysis and Intensive Care Unit, Lapeyronie Hospital, CHU Montpellier, Montpellier, France
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García-Familiar A, Ortiz-Gutiérrez F, De Blas-Bravo M, Sánchez-Abuín J, Rodríguez Sáenz de Buruaga V, Egaña-Barrenechea JM. Isolated Spontaneous Renal Artery Dissection: Endovascular Management. Ann Vasc Surg 2014; 28:1034.e5-8. [DOI: 10.1016/j.avsg.2013.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 06/08/2013] [Accepted: 06/13/2013] [Indexed: 11/15/2022]
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Yokoyama S, Sekioka A, Utsunomiya H, Shimada K. Traumatic renal artery occlusion associated with a grade III hepatic injury in an 11-year-old boy: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Jain A, Tracci MC, Coleman DM, Cherry KJ, Upchurch GR. Renal malperfusion: spontaneous renal artery dissection and with aortic dissection. Semin Vasc Surg 2013; 26:178-88. [DOI: 10.1053/j.semvascsurg.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Desai NS, Saboo SS, Khandelwal A, Steigner ML, Rybicki FJ. Imaging Findings of Spontaneous Bilateral Renal Artery Dissection. Urology 2013; 82:e33-4. [DOI: 10.1016/j.urology.2013.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/21/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
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8
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Abdel-Kerim A, Cassagnes L, Alfidja A, Gageanu C, Favrolt G, Dumousset E, Ravel A, Boyer L, Chabrot P. Management of isolated non-traumatic renal artery dissection: report of four cases. Acta Radiol 2012; 53:401-5. [PMID: 22517982 DOI: 10.1258/ar.2012.110303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Isolated non-traumatic renal artery dissection (RAD) is a rare disorder with uncertain natural history. The management may be surgical reconstruction, endovascular repair, or conservative medical treatment, yet no official consensus had been established. PURPOSE To report the management of four cases of isolated non-traumatic RAD, emphasizing the beneficial role of conservative medical treatment. MATERIAL AND METHODS From the year 2000 till 2011, four male patients with mean age of 42.5 years (range 34-48 years) presented with isolated non-traumatic RAD and were initially treated with medical therapy. Transcatheter in situ thrombolysis was performed in a case with thrombotic occlusion. RESULTS Isolated non-traumatic RAD in four patients involving at least seven branches progressed to thrombotic occlusion in two branches, luminal narrowing in five, dual lumens in two, and aneurysmal dilatation in three. Medical treatment was efficacious in three patients, who showed persistent preserved renal function, controlled blood pressure, and favorable arterial remodeling. After failure of medical therapy, the fourth patient was referred to surgery. Thrombolysis was successful to dissolute an occluding thrombotic dissection. CONCLUSION Conservative therapy is safe and effective when the renal artery is patent and blood pressure is controlled: we propose it as the first line of treatment, reserving interventional management for refractory cases.
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Affiliation(s)
- Amr Abdel-Kerim
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
- Department of Diagnostic and Interventional Radiology, Alexandria University Hospital, Alexandria University, Alexandria, Egypt
| | - Lucie Cassagnes
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Agaicha Alfidja
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Cristian Gageanu
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Gregory Favrolt
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Eric Dumousset
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Anne Ravel
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Louis Boyer
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
| | - Pascal Chabrot
- Department of Radiology, Clermont Ferrand University Hospital, Université D'Auvergne, Clermont Ferrand, France
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Muroya T, Koga S, Maemura K. Chronic renal artery dissection with aneurysm formation treated by stent implantation with coil embolization with detailed intravascular ultrasound evaluation. Catheter Cardiovasc Interv 2012; 81:574-7. [PMID: 22511619 DOI: 10.1002/ccd.24308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 12/21/2011] [Indexed: 11/10/2022]
Abstract
Treatment options for chronic renal artery dissection, which is a rare cause of renal artery stenosis and renovascular hypertension, such as medical management, percutaneous intervention, and open surgical repair remain controversial. We describe a 55-year-old man with a chronic dissecting aneurysm of a renal artery complicated with renovascular hypertension that was initially diagnosed by computed tomography angiography, evaluated by intravascular ultrasound, and treated by stent implantation with coil embolization.© 2012 Wiley Periodicals, Inc.
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Affiliation(s)
- Takahiro Muroya
- Department of Cardiology, Ureshino Medical Center, Ureshino, Japan
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Tsai TH, Su JT, Hu SY, Chao CC, Tsan YT, Lin TC. Spontaneous Renal Artery Dissection Complicating With Renal Infarction. Urology 2010; 76:1371-2, 1372.e1. [DOI: 10.1016/j.urology.2009.12.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 12/23/2009] [Accepted: 12/29/2009] [Indexed: 11/15/2022]
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Pellerin O, Garçon P, Beyssen B, Raynaud A, Rossignol P, Jacquot C, Plouin PF, Sapoval M. Spontaneous renal artery dissection: long-term outcomes after endovascular stent placement. J Vasc Interv Radiol 2009; 20:1024-30. [PMID: 19647181 DOI: 10.1016/j.jvir.2009.04.069] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 04/22/2009] [Accepted: 04/30/2009] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report long-term clinical and morphologic results after stent placement for spontaneous renal artery dissection (SRAD). MATERIALS AND METHODS Between 1991 and 2006, 16 consecutive patients (13 men; mean age, 42 y +/- 12) presented with SRAD in 17 arteries. All patients had uncontrolled hypertension at the time of presentation. Nine patients had lower back pain, 10 had progressive renal insufficiency, and three had both. All patients underwent renal angiography and stent implantation. They were followed up clinically and with renal imaging. RESULTS Baseline blood pressure and plasma creatinine levels were 176/107 mm Hg and 142 micromol/L, respectively. Successful renal artery recanalization and stent implantation were achieved in all patients. After a mean follow-up of 8.6 years +/- 3.4, mean blood pressure was 118/78 mm Hg, with Seven patients were taking no antihypertensive medication, with five and four patients taking single or double antihypertensive agents, respectively. The most recent follow-up showed that plasma creatinine levels were normal, and imaging of the renal arteries showed no sign of restenosis or occlusion in all patients. CONCLUSIONS Stent implantation for symptomatic SRAD is an effective treatment in the long term and represents a safe alternative to surgery.
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Affiliation(s)
- Olivier Pellerin
- Cardiovascular and Interventional Radiology Department, Georges Pompidou European Hospital, Paris 5, René Descartes University, 20 rue Leblanc, Paris Cedex 15, France.
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Renal infarction caused by spontaneous renal artery dissection: treatment with catheter-directed thrombolysis and stenting. Cardiovasc Intervent Radiol 2008; 32:333-6. [PMID: 19005722 DOI: 10.1007/s00270-008-9465-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 10/08/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
Spontaneous renal artery dissection (SRAD) is rare and presents a diagnostic and therapeutic challenge. We report a case of a 36-year-old man who had an SRAD-complicated renal infarction. The patient experienced severe unilateral flank pain. Enhanced abdominal computed axial tomography scan showed renal infarction, and urinalysis showed no hematuria. Selective renal angiography was essential to evaluate the extent of dissection and suitability for repair. The patient was treated with catheter-directed thrombolysis and frenal artery stenting.
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Yamanouchi Y, Yamamoto K, Noda K, Tomori K, Kinoshita T. Renal Infarction in a Patient With Spontaneous Dissection of Segmental Arteries: Diffusion-Weighted Magnetic Resonance Imaging. Am J Kidney Dis 2008; 52:788-91. [DOI: 10.1053/j.ajkd.2008.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Accepted: 07/11/2008] [Indexed: 11/11/2022]
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Abstract
Renal artery dissection may be caused by iatrogenic injury, trauma, underlying arterial diseases such as fibromuscular disease, atherosclerotic disease, or connective tissue disease. Radiological imaging may be helpful in detecting renal artery pathology, such as renal artery dissection. For patients with acute, isolated renal artery dissection, surgical treatment, endovascular management, or medical treatment have been considered effective measures to preserve renal function. We report a case of renal infarction that came about as a consequence of renal artery dissection.
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Affiliation(s)
- Kyung Pyo Kang
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sik Lee
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Won Kim
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Gong Yong Jin
- Department of Diagnostic Radiology, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Ki Ryang Na
- Department of Internal Medicine, Chungnam National University Medical School, Daejeon, Korea
| | - Il Yong Yun
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kwang Park
- Department of Internal Medicine, Renal Regeneration Laboratory, Chonbuk National University Medical School, Jeonju, Korea
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Hahm YI, Sim YJ, Park KS, Park YS, Joo KJ, Kwon CH, Park HJ. Spontaneous Renal Artery Dissection Complicated by Renal Infarction. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.4.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Young Il Hahm
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Young Jin Sim
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Kyung Seo Park
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yong Seol Park
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Kwan Joong Joo
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Chil Hoon Kwon
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Heung Jae Park
- Department of Urology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Ullrick SR, Wojtowycz M. Utility of percutaneous treatment in spontaneous renal artery dissection: case report and review of the literature. Semin Intervent Radiol 2007; 24:63-7. [PMID: 21326739 DOI: 10.1055/s-2007-971188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spontaneous renal artery dissection (SRAD) is a relatively rare entity that has been described in several case reports and small series in the medical literature. The condition is best diagnosed with angiography, with renal ischemia or infarction a common complication. Conservative medical management, surgical intervention, and percutaneous intervention are all discussed in the current literature. However, there is no consensus on which treatment option provides the best clinical outcome. Percutaneous stent placement has only recently been considered as an option for treatment of SRAD. This case report reviews the course of an otherwise healthy patient with a solitary right kidney who had SRAD complicated by renal infarction and was treated by percutaneous renal artery stent placement. Subsequently, we discuss and review the literature on SRAD treatment.
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Affiliation(s)
- Steven R Ullrick
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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