EURORAD ESR

Case 8957

Persistent nephrogram sign heralding contrast-induced nephrotoxicity

Author(s)
Tonolini M, Ippolito S, Bianco R.
Radiology Department, "Luigi Sacco" Hospital, Milan, Italy.
 
Patient
female, 83 year(s)
 
 
  • Figure 1
    Chest X-ray and angio-MDCT
     

    Semisupine A-P chest radiograph shows retracting upper lobe consolidation and obliteration of the ipsilateral costophrenic angle. No significant hilar and cardiac acute abnormalities.

     
    Area of Interest: Thorax; Imaging Technique: Plain radiographic studies; Special Focus: Infection;

    Chest CT scans (b at lung window, c at mediastinal window) confirm right upper lobe pneumonic-atelectatic consolidation associated with ipsilateral pleural effusion.

     
    Area of Interest: Thorax; Imaging Technique: CT; Special Focus: Infection;

    Chest CT scans (b at lung window, c at mediastinal window) confirm right upper lobe pneumonic-atelectatic consolidation associated with ipsilateral pleural effusion.

     
    Area of Interest: Thorax; Imaging Technique: CT; Special Focus: Infection;

    Pulmonary CT (d,e) angiography ruled out suspected acute thromboembolism. Discrete stenosis of the distal right bronchus is noted.

     
    Area of Interest: Thorax; Imaging Technique: CT-Angiography; Special Focus: Embolism / Thrombosis;

    Pulmonary CT (d,e) angiography ruled out suspected acute thromboembolism. Pleural effusion is present on the right.

     
    Area of Interest: Thorax; Imaging Technique: CT-Angiography; Special Focus: Embolism / Thrombosis;
     
     
  • Figure 2
    Serum Creatinine levels

    Graph showing progressively increasing serum Creatinine levels (85 micromol/L at admission) during hospitalization.

     
    Area of Interest: Kidney; Procedure: Laboratory tests; Special Focus: Metabolic disorders;
     
     
  • Figure 3
    Abdominal scout-view and unenhanced CT acquisition
     

    CT preliminary scout-view shows persistent opacification of the renal parenchyma (persistent nephrogram sign) and collecting systems, 18 hours after initial contrast-enhanced CT.

     
    Area of Interest: Kidney; Imaging Technique: Plain radiographic studies; Special Focus: Drugs / Reactions;

    Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range...

     
    Area of Interest: Kidney; Imaging Technique: CT; Special Focus: Drugs / Reactions;

    Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range...

     
    Area of Interest: Kidney; Imaging Technique: CT;

    Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range...

     
    Area of Interest: Kidney; Imaging Technique: CT; Special Focus: Drugs / Reactions;

    Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range...

     
    Area of Interest: Kidney; Imaging Technique: CT; Special Focus: Drugs / Reactions;
     
     
  • Figure 4
    Abdominal unenhanced CT - other findings
     

    Axial scans (a,b) in the upper abdomen document opacification of the gallbladder lumen content, plus incidental finding of multiple hypodense liver lesions bilateral adrenal solid masses.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Special Focus: Neoplasia;

    Axial scans (a,b) in the upper abdomen document opacification of the gallbladder lumen content, plus incidental finding of multiple hypodense liver lesions bilateral adrenal solid masses.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Special Focus: Neoplasia;

    Axial scan of the pelvis shows long segment of sigmoid colon with hypersegmentation, mural thickening and inflamed surrounding fat planes, consisting with uncomplicated acute diverticulitis. Excreted contrast medium...

     
    Area of Interest: Pelvis; Imaging Technique: CT; Procedure: Abscess delineation; Special Focus: Inflammation;
     
     
Semisupine A-P chest radiograph shows retracting upper lobe consolidation and obliteration of the ipsilateral costophrenic angle. No significant hilar and cardiac acute abnormalities.
 
Chest CT scans (b at lung window, c at mediastinal window) confirm right upper lobe pneumonic-atelectatic consolidation associated with ipsilateral pleural effusion.
 
Chest CT scans (b at lung window, c at mediastinal window) confirm right upper lobe pneumonic-atelectatic consolidation associated with ipsilateral pleural effusion.
 
Pulmonary CT (d,e) angiography ruled out suspected acute thromboembolism. Discrete stenosis of the distal right bronchus is noted.
 
Pulmonary CT (d,e) angiography ruled out suspected acute thromboembolism. Pleural effusion is present on the right.
 
Graph showing progressively increasing serum Creatinine levels (85 micromol/L at admission) during hospitalization.
 
CT preliminary scout-view shows persistent opacification of the renal parenchyma (persistent nephrogram sign) and collecting systems, 18 hours after initial contrast-enhanced CT.
 
Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range 210-240.
 
Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range 210-240.
 
Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range 210-240.
 
Unenhanced volumetric CT acquisition (axial scan in a, coronal in b and sagittal in c-d reformations) document intense persistent opacification of renal parenchyma. Renal cortical attenuation measured in the range 210-240.
 
Axial scans (a,b) in the upper abdomen document opacification of the gallbladder lumen content, plus incidental finding of multiple hypodense liver lesions bilateral adrenal solid masses.
 
Axial scans (a,b) in the upper abdomen document opacification of the gallbladder lumen content, plus incidental finding of multiple hypodense liver lesions bilateral adrenal solid masses.
 
Axial scan of the pelvis shows long segment of sigmoid colon with hypersegmentation, mural thickening and inflamed surrounding fat planes, consisting with uncomplicated acute diverticulitis. Excreted contrast medium in the bowel lumen.
 
 
 
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