Renal Infarction: CT Findings - Focal vs global involvement - Usually due to arterial occlusion sudden in onset - May be unilateral or bilateral depending on the etiology - Cortical rim sign may be seen with global infarction - Chronic renal infarction may be seen as a small kidney
“The diagnosis of renal infarction is suggested by an elevated LDH. The diagnosis itself is typically made with computed tomography. The image above is typical. A wedge shaped lesion that does not enhance with contrast is seen. The extent of the infarction depends on which renal artery was occluded and at what level.” Renal Infarction Weinberg I Vascular Medicine Sept 2011
“A renal infarction results from disruption of blood flow to the kidney. The disruption can result from an embolus arising in a distant location or from thrombosis of the renal artery. Local renal arterythrombosis can be spontaneous or secondary to trauma. Once the diagnosis is made the reason for the infarction needs to be found. Treatment starts with anticoagulation. Duration of therapy and other treatments such as endovascular intervention depend on the cause, amount of renal damage and hypertension that may result.” Renal Infarction Weinberg I Vascular Medicine Sept 2011
“Although most of our cases were straightforward for the diagnosis of renal infarction, cases with tumefactive lesions and global infarctions without the well-known cortical rim sign were particularly challenging. We describe a new sign, flip-flop enhancement pattern, which we believe solidified the diagnosis of renal infarction in five of our cases. The authors recommend further investigations for association of flip-flop enhancement and renal infarction.” CT Features of Renal Infarction Suzer O et al. Eur J Radiol 2002 Oct;44(1):59-64
“Acute renal infarction is not as rare as previously assumed. The entity is often misdiagnosed. Unilateral flank pain in a patient with an increased risk for thromboembolism should raise the suspicion of renal infarction. In such a setting, hematuria, leucocytosis and an elevated LDH level are strongly supportive of the diagnosis.” The Clinical Spectrum of Acute Renal Infarction Korzets Z et al. Isr Med Assoc J 2002 Oct;4(10):781-4
Renal Infarction: Facts - Can be segmental or global in extent - Can be an isolated process or part of multisystem disease involvement - Acute and chronic renal infarction due occur - Symptoms may range from acute flank pain, to FUO to hematuria
"Underlying embolic and hemorrhagic complications are common in patients with acute nontraumatic abdominal pain in the setting of atrial fibrillation and can be accurately seen on CT."
Spectrum of CT Findings in Patients with Atrial Fibrillation and Nontraumatic Acute Abdomen Barajas RF et al. AJR 2009;193:485-492
