Presentation
Right sided abdominal pain.
Patient Data
Multiple areas of low density in the right renal parenchyma. Well defined edges to these low density areas. No mass lesions. Small volume of perinephric fat stranding. No vascular abnormalities such as thrombus or dissection. Normal appearances of left kidney and other abdominal organs. No other abnormalities.
There has been interval atrophy of some of the right renal parenchyma. A new finding is the presence of multiple areas of well-defined low density involving the left kidney. There is low density filling the lumen of the left renal artery, close to the kidney. New small area of low density in spleen, consistent with infarct. There is also irregular low density within the lumen of the left atrial appendage, applied to the anterior wall. There is no sign of ischemic change in other solid abdominal organs, or the small or large bowel.
Case Discussion
There are some interesting learning points in this case:
On the initial CT, the presence of well-defined, low density regions within the right kidney is suggestive of infarcts.
The evolution of infarcts is demonstrated, with regional atrophy of the infarcted parts of the right kidney shown on the second study.
New infarcts are present within the left kidney and the spleen on the second CT, and the sharp demarcation between infarcted kidney and normal kidney is a good sign of ischemic change, as opposed to infiltrative disorders, such as lymphoma IgG4 disease.
It is important to look for a central source of thrombus, such as within the left atrial appendage, and the lumen of the thoracic and abdominal aorta.
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