Figure 1
Spontaneous renal artery dissection
Clinical History
Acute flank pain.
Imaging Findings
The patient presented with acute flank pain and urolithiasis was suspected.
Contrast-enhanced helical computed tomography revealed a large infarct of the left kidney and showed a thin line of contrast-filled true lumen in the left renal artery. Angiography confirmed dissection with compression of the true lumen by an occluded and enlarged false lumen.
The patient was treated conservatively. He was anticoagulated with warfarin. The patient also required antihypertensive treatment following dissection, but the hypertension was easily controlled.
Contrast-enhanced helical computed tomography revealed a large infarct of the left kidney and showed a thin line of contrast-filled true lumen in the left renal artery. Angiography confirmed dissection with compression of the true lumen by an occluded and enlarged false lumen.
The patient was treated conservatively. He was anticoagulated with warfarin. The patient also required antihypertensive treatment following dissection, but the hypertension was easily controlled.
Discussion
Spontaneous renal artery dissection is rare and may be misdiagnosed because its clinical presentation is confusing. Diagnosis is usually made by angiography. The causes of renal artery dissection include blunt trauma, angioplasty, and atherosclerosis of the renal artery. Spontaneous arterial dissection can be associated with fibromuscular dysplasia, medial degeneration, polyarteritis nodosa, Marfan syndrome or syphilitic arteritis.
The most common presenting signs of renal artery dissection are flank pain, hypertension, headache, and abdominal bruit. Minimal proteinuria and microscopic hematuria may be detected, and dissection can lead to segmental or total renal infarction.
Conservative management is often indicated, and the long-term prognosis is generally excellent. Patients may also be treated surgically or with endovascular revascularisation. Surgical treatment of spontaneous renal artery dissection is indicated in patients who have hypertension despite medical treatment. Management methods for spontaneous renal artery dissection are surgical revascularisation, endovascular treatment, and medical treatment with or without anticoagulation. In the literature, a clear method of treatment with any of these modalities was not demonstrated. Some kidneys were lost due to irreversible ischaemic damage from an occlusive dissection. Isolated renal artery dissection is an uncommon lesion that can cause renal parenchymal loss and hypertension.
The most common presenting signs of renal artery dissection are flank pain, hypertension, headache, and abdominal bruit. Minimal proteinuria and microscopic hematuria may be detected, and dissection can lead to segmental or total renal infarction.
Conservative management is often indicated, and the long-term prognosis is generally excellent. Patients may also be treated surgically or with endovascular revascularisation. Surgical treatment of spontaneous renal artery dissection is indicated in patients who have hypertension despite medical treatment. Management methods for spontaneous renal artery dissection are surgical revascularisation, endovascular treatment, and medical treatment with or without anticoagulation. In the literature, a clear method of treatment with any of these modalities was not demonstrated. Some kidneys were lost due to irreversible ischaemic damage from an occlusive dissection. Isolated renal artery dissection is an uncommon lesion that can cause renal parenchymal loss and hypertension.
Differential Diagnosis List
Spontaneous renal artery dissection
Final Diagnosis
Spontaneous renal artery dissection
References
[1]
Lok SY, Chalvardjian A, Common AA.
Primary renal artery dissection.
Can Assoc Radiol J 1995 Feb;46(1):54-6. (PMID: 7834490)
[2]
Paul JF, Blacher J, Blancher JF, Sapoval M, Safar M, Gaux JC.
Spontaneous renal artery dissection revealed by helical CT angiography.
Eur Radiol 2000;10(5):783-5. (PMID: 10823634)
[3]
Boughey JC, Gifford RR, Collins JB, Close TP.
Spontaneous renal artery dissection in a healthy man.
J S C Med Assoc 2001 Jun;97(6):246-9. (PMID: 11434110)
Case information
| URL: | https://www.eurorad.org/case/1929 |
| DOI: | 10.1594/EURORAD/CASE.1929 |
| ISSN: | 1563-4086 |
Figure 2
Spontaneous renal artery dissection
AP angiogram demonstrates false lumen occlusion. Renal vascularisation is not opacified with this injection.
AP angiogram shows a thin line of true lumen. The lower pole of the left kidney is vascularized by this thin true lumen. The other parts of the kidney are not seen due to false lumen occlusion.
Spontaneous renal artery dissection
AP angiogram demonstrates false lumen occlusion. Renal vascularisation is not opacified with this injection.
AP angiogram shows a thin line of true lumen. The lower pole of the left kidney is vascularized by this thin true lumen. The other parts of the kidney are not seen due to false lumen occlusion.