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Introduction: Acute renal infarction is a rare occurence, whose  prognosis and long-term outcomes remain poorly studied. This study evaluated whether clinical and radiological features at diagnosis can be associated with the long-term outcomes (blood pressure, kidney function and mortality)., Methods: We retrospectively analyzed the demographic, clinical, biological and radiological data of patients with acute renal infarction hospitalized at Rennes University Hospital between 1997 and 2017 (n = 94)., Results: Patients were followed-up for a median of 60 months. At time of diagnosis of acute renal infarction median age was 53 years, 45% of the patients had acute hypertension, and 31% had Acute Kidney Injury (AKI) requiring dialysis in seven patients. The median Lactate DeHydrogenase (LDH) level was 977 IU/mL. The median extent of kidney damage was 14%, with left renal involvement in 51% of patients. At 60 months of follow-up, 66% of patients had developed Chronic Kidney Disease (CKD) stage 3 or higher, and 55% had hypertension since diagnosis. Age, acute development of hypertension and AKI at diagnosis were associated with long-term CKD (stage 3 or higher) in multivariate analyses, but the extent of kidney damage was not. During the follow-up, 21% of patients died, and only age resulted as a predisposing factor. No tested factor was correlated with long-term hypertension., Discussion: Age, acute development of hypertension, and AKI were correlated with long term CKD, whereas no factor was correlated with long-term hypertension after acute renal infarction., (© 2021. Italian Society of Nephrology.)

Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.

Purpose: Renal infarction is a clinical condition which is caused by renal artery occlusion and leads to permanent renal parenchymal damage. In the literature, there are generally case reports on this subject, and few studies that include a large group of patients. Therefore, we aimed to present the data of a large group of patients who were diagnosed with acute renal infarction in our country in this retrospective study., Methods: The data of patients who were diagnosed with acute renal infarction according to clinical and radiological findings in Turkey in the last 3 years were examined. For this purpose, we contacted with more than 40 centers in 7 regions and obtained support from clinically responsible persons. Demographic data of patients, laboratory data at the time of diagnosis, tests performed for etiologic evaluation, given medications, and patients' clinical status during follow-up were obtained from databases and statistical analysis was performed., Results: One-hundred and twenty-one patients were included in the study. The mean age was 53 ± 1.4 (19-91) years. Seventy-one (58.7%) patients were male, 18 (14.9%) had diabetes, 53 (43.8%) had hypertension, 36 (30%) had atrial fibrillation (AF), and 6 had a history of lupus + antiphospholipid syndrome (APS). Forty-five patients had right renal infarction, 50 patients had left renal infarction, and 26 (21.5%) patients had bilateral renal infarction. The examinations for the ethiologies revealed that, 36 patients had thromboemboli due to atrial fibrillation, 10 patients had genetic anomalies leading to thrombosis, 9 patients had trauma, 6 patients had lupus + APS, 2 patients had hematologic diseases, and 1 patient had a substance abuse problem. Fifty-seven (57%) patients had unknown. The mean follow-up period was 14 ± 2 months. The mean creatinine and glomerular filtration rate (GFR) values at 3 months were found to be 1.65 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively. The final mean creatinine and GFR values were found to be 1.69 ± 0.16 mg/dl and 62 ± 3 ml/min, respectively., Conclusions: Our study is the second largest series published on renal infarction in the literature. More detailed studies are needed to determine the etiological causes of acute renal infarction occurring in patients.

Background: Acute renal infarction (ARI) is a rare disease with atrial fibrillation being its main cause. The possible laterality of ARI is controversial. This study aimed to evaluate the association between anatomical features of the renal arteries and ARI., Methods: This was a single-center cross-sectional study that evaluated the anatomical and clinical features of renal arteries. The anatomical features of the renal arteries were assessed using computed tomography., Results: A total of 46 patients (mean age 71.3 ± 14.0 years; men, 59%) were enrolled. ARI involved the left kidney in 63%, right kidney in 28%, and both kidneys in 9% of patients. The right renal artery orifice was often higher than that of the left renal artery (71%). The angle of divergence from the abdominal aorta was similar on both sides. The left renal artery orifice was larger than that of the right (83 ± 24, 72 ± 24 mm 2 ; p = 0.03, respectively). A larger left orifice was present in 72% of all cases. ARI involved the side with the larger orifice in 64% of patients., Conclusion: The size of the renal artery orifice may be a factor that contributes to the laterality of ARI. Assessment of anatomical features is important when considering the laterality of the disease.

Torsion of a nongravid uterus is rare, as most cases of uterine torsion occur during pregnancy. We report a case of a large ovarian cyst causing uterine torsion, infarction, and rupture. A 57-year-old woman presented with acute-onset abdominal pain and increasing abdominal girth over the past year. Contrast-enhanced computed tomography (CT) demonstrated axial rotation and swirling of the uterus and the mesenteric fat, leading to a preoperative diagnosis of uterine torsion. Laparotomy confirmed that the uterine corpus had undergone a 180-degree axial rotation, and further revealed uterine wall infarction and rupture into the endometrium as well as partial decapitation of the uterus from the cervix. The swirled appearance of the uterus, radiologically similar to the "whirlpool sign" seen in bowel volvulus, is an important CT finding to recognize, especially in view of the risk of irreversible ischemic complications this uncommon entity may inflict on the uterus.

Infarction in the artery of Percheron territory is a rare phenomenon in which occlusion of an unpaired perforating artery arising from the P1 segment on one side results in infarcts in the bilateral paramedian thalami with or without midbrain infarcts. We describe the case of a 40-year-old male who developed this complication following re-exploratory trans-sphenoidal surgery for a pituitary adenoma. In this first report of its kind in endoscopic pituitary surgery, the pathogenesis and clinico-radiological features of this rare vascular event are discussed.

Antiphospholipid syndrome (APS), a leading entity in acquired thrombophilia, is characterized by recurrent thrombosis, morbidity in pregnancy and presence of antiphospholipid antibodies (APA). Although the etiopathogenesis is unclear, APA against negatively charged phospholipids and phospholipid-protein complexes are held responsible for the clinical picture. In case of acute thrombosis due to APS, thrombolytic therapy is not a commonly administered treatment option. Here, we present a case with acute thrombosis in the left renal artery showing partial response to thrombolytic therapy.

Diabetic muscle infarction, also known as diabetic myonecrosis, is a microvascular complication of poorly controlled diabetes mellitus characterized by unilateral limb pain and swelling. Because these symptoms closely mimic cellulitis and thromboembolism, diagnosis is often delayed or missed altogether, leading to increased morbidity and inappropriate treatment. We describe a case of unilateral limb pain and swelling due to diabetic muscle infarction in a 36-year-old patient with poorly controlled diabetes mellitus. We also review the literature on the diagnosis, prognosis, and management of this under-recognized condition., Competing Interests: The authors declare that they do not have a conflict of interest.

Introduction: The clinico-radiological characteristics and the natural history of postoperative omental infarct (OI) in patients who underwent distal pancreatectomy (DP) and splenectomy have not been defined., Materials and Methods: Twelve patients who underwent DP over a period of 2 years and were postoperatively diagnosed with OI based on computed tomography (CT) findings were identified., Results: A total of 12 patients were diagnosed with an OI based on their postoperative imaging. Seven (58.3 %) patients had previously undergone laparoscopic DP, one (8.3 %) had undergone a robotic DP, and in one (8.3 %), a laparoscopic DP was converted to an open procedure. The remaining three (25.1 %) were treated with open DP. In five (41.6 %) patients, the diagnosis of OI was made during routine follow-up. One patient underwent surgical resection of OI, and two had drains placed in the mass. Nine patients were managed conservatively. During the study period, on review of CT imaging, the minimum prevalence of postoperative OI after DP was found to be 22.8 %. A review of literature identified nine articles that reported a total of 34 patients who were diagnosed with OI after abdominal surgery., Conclusion: The management of an asymptomatic postoperative OI should be conservative while an early invasive intervention should be performed in patients who are symptomatic or have infected OI.

Fibromuscular dysplasia (FMD) is a noninflammatory nonatherosclerotic vascular disease. It is the second cause of renovascular hypertension after atherosclerosis. Although FMD usually has a good prognosis, renal infarctions and artery dissections have been described. We present the case of a 38-year-old woman with hypertension and asymptomatic bilateral renal infarctions. Bilateral FMD of segmental branches of the renal arteries was diagnosed by digital subtraction angiography after an exhaustive study. Previous intake of nonsteroidal anti-inflammatory drugs may also have played a significant role in the development of renal infarctions. To our knowledge, bilateral renal infarctions complicating FMD have been reported in only four previous cases; only in one of those cases, renal infarctions were asymptomatic.

Fibromuscular dysplasia (FMD) describes a group of conditions which cause nonatheromatous arterial stenoses, most commonly of the renal and carotid arteries, typically in young women. We report the case of a previously healthy 43-year-old white man presenting with acute bilateral flank pain. The pain was more severe on the left side. Initially treated for ureteral colic, he was transferred to the nephrology unit upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with resultant infarctions in both kidneys. He was treated with intravenous heparin and, then, warfarin at discharge. At a 16-month review, the patient remained pain-free with normal renal function and with antiplatelet and dual antihypertensive therapy. In conclusion, renal infarction complicating FMD is rare, with most cases involving causative cardiovascular risk factors, including coagulopathy, ischemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. What makes this case interesting are the clinically significant bilateral renal infarctions due to atypical asymmetric FMD in both kidneys in a young man.

Patients treated with anti-VEGF agents are at increased risk for arterial thrombo-embolic events (ATEs). However, the pathophysiology of such acute vascular complications remains unclear. We report on a case of bowel infarction in a renal cancer patient treated with the anti-VEGF agent sunitinib. An abdominal CT-scan evidenced the rupture of an atherosclerotic plaque located at the emergence of the superior mesenteric artery. In view of this report, we suggest that evaluation of the risk of ATE in patients receiving anti-VEGF agents should include not only age and past history of ATE as suggested by previous studies, but also assessment of atherosclerotic lesions on CT-scan.

A 22-year-old woman, who often carried heavy books, was admitted for evaluation of hyperreninemic hypertension. Two months prior to admission, she noted leg edema. Radiological examinations revealed bilateral renal infarction with no other abnormal findings. An echocardiography showed a patent foramen ovale (PFO). Hypertension was considered secondary to renal infarction caused by paradoxical embolism through PFO. Antihypertensive and anticoagulant therapy led to improvement of hypertension. In previously reported cases of renal paradoxical embolism, multiorgan involvement was usually observed. Our case is unique in that embolism was confirmed only in the kidneys, and that clinical characteristics of renal embolism were not observed.

A 47-year-old female complained of abdominal pain in the epigastrium for about 2 h after a meal. At the initial abdominal radiograph, there were no findings of remarkable bowel loops. On the following day of hospitalization, the pain became worse; moreover, it could not be controlled by medicine. Also, a dilated bowel loop was detected on the imaging studies. When exploring the peritoneal cavity, we found a strangulated small bowel that protruded through the lesser omental sac within the defects of the gastrocolic or gastrohepatic ligaments. After performing manual reduction, the restoring viability of herniated small bowel failed; consequently, extensive small bowel resection was mandatory. Herein we reported a case of extensive small bowel hemorrhagic infarction due to a double omental hernia that was not diagnosed at the time of visiting the emergency department.

Background: Postoperative hepatic infarction is rare; therefore, clinical characteristics and outcomes of postoperative hepatic infarction after pancreatobiliary surgery have not been obvious., Methods: Eleven patients encountered hepatic infarction after pancreato-biliary surgery. Management, clinical course, and outcome of these 11 patients were retrospectively analyzed., Results: Possible causes of the hepatic infarction were inadvertent injury of the hepatic artery during lymph node dissection in five patients, right hepatic artery ligation in two patients, long-term clamp of the hepatic artery during hepatic arterial reconstruction in two patients, suturing for bleeding from the right hepatic artery in one patient, and celiac axis compression syndrome in one patient. Five of the 17 infarcts extended for one whole section of the liver, and distribution of the other 12 was less than one section. Ten patients discharged from hospital; however, one patient died of sepsis of unknown origin., Conclusions: Attention should be paid to inadvertent injury of hepatic artery to prevent hepatic infarction. Hepatic infarctions after pancreato-biliary surgery seldom extend to the entire liver and most of them are able to be treated without intervention.

Dego's disease is an uncommon thrombo-occlusive vasculopathy that presented with skin rash and thrombotic complications affecting internal organs that may simulate rheumatic diseases and may be brought to the attention of rheumatologists. We present here a case of a middle-aged woman who presented with acute bowel infarction, persistent fever, elevated inflammatory markers and reversed albumin/globulin ratio suspicious of systemic vasculitis clinically. The diagnosis of Dego's disease was made from the classical skin lesions which were pink to brown papules with central depression and surrounding violaceous rim that were distributed over the trunk and extremities. Histology showed typical wedge-shaped infarction in the affected organs with endothelial proliferation and occlusion by thrombus. Our patient was put on aspirin but suffered from recurrent bowel infarction 1.5 years later and eventually succumbed to septic complications.

Giant cell arteritis predominantly affects cranial arteries and rarely involves other sites. We report a patient who presented with small bowel obstruction because of infarction from mesenteric giant cell arteritis. She had an unusual cause of her obstruction and a rare manifestation of giant cell arteritis. In spite of aggressive therapy with steroids, she died a month later because of multiple complications. We discuss the diagnosis and management of small bowel obstruction and differential diagnosis of vasculitis of the gastrointestinal tract. We were able to find 11 cases of bowel involvement with giant cell arteritis in the English literature. This case report illustrates that giant cell arteritis can be a cause of small bowel obstruction and bowel infarction. In the proper clinical setting, vasculitides need to be considered early in the differential diagnosis when therapy may be most effective.

Calcific uremic arteriolopathy (CUA) is a rare complication of end-stage renal disease in which thrombosis occurs in calcified arteries, leading to infarction and infection of the affected tissues. This brief report describes a fatal case of CUA which presented with intestinal involvement, significantly before the onset of classical skin lesions. It is essential to raise awareness of this rare but clinically relevant form of presentation of CUA. The diagnostic and treatment issues are discussed in this case.

We report a 27-year-old woman with renovascular hypertension, renal infarction, and hepatic artery aneurysm due to fibromuscular dysplasia. The patient was first noted to have renal artery aneurysm and hepatic artery aneurysm at the age of 17. The renal infarction was asymptomatic and was incidentally detected by magnetic resonance imaging (MRI) examination. Because of the rather peripheral location of the aneurysms, percutaneous transluminal renal artery angioplasty was considered inappropriate. This case suggests the need for long-term and periodical follow-up of patients with fibromuscular dysplasia.

Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome is a thrombotic microangiopathy complicating pregnancy and shares many clinical and biological features with thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). Thrombotic microangiopathy is also a pathological feature of catastrophic antiphospholipid syndrome (CAPS). An association between refractory HELLP syndrome and antiphospholipid syndrome (APS) has been reported in a few cases. We describe a 19-year-old woman with APS and multiorgan failure conforming to a diagnosis of CAPS who developed refractory HELLP syndrome.

A 70-year-old patient with acute renal infarction due to chronic atrial fibrillation is presented. The clinical presentation of the patient was suggestive of renal colic. Computerized tomography was consistent with acute renal infarction and confirmed the diagnosis. After giving anticoagulation and antiarrhythmic treatment, she was discharged with clinical improvement. High clinical suspicion is necessary on an old patient who has thromboembolic risk factors with the complaint of abrupt-onset flank pain.

Thromboembolism is a well-recognized complication in patients with nephrotic syndrome owing to their hypercoagulable status. Usually, the venous system is affected, whereas the very rare occurrence of arterial thrombosis is mainly restricted to pediatric patients. This complication often results in high rates of mortality and limb loss. We report the case of an adult female patient with histologically diagnosed minimal change disease and nephrotic syndrome associated with malignant thymoma, who eventually developed concurrent bilateral kidney and lower limb thrombosis. Conservative systemic anticoagulation was administered and she recovered ample kidney function. In addition, although she underwent an emergent thrombectomy of the left popliteal artery, an amputation was necessary. To the best of our knowledge, this is the first reported arterial thrombosis case involving bilateral kidney and lower limb simultaneously in nephrotic patients. Our experience indicates that arterial thrombosis is a serious complication in nephrotic patients, and early detection and aggressive management are crucial in these patients to improve their outcome.

The incidence of abdominal pain in patients with systemic lupus erythematosus (SLE) is very high. Most patients do not require surgical treatment (serositis). Some cases such as appendicitis, perforated ulcer, cholecystitis or, rarely, intestinal infarction are surgical. Differential diagnosis is difficult, partly because noninvasive examinations do not provide enough evidence to rule out a diagnosis. On the other hand, in patients with SLE who have acute abdomen, it is dangerous to delay surgery by attempting conservative therapy. In fact, a better survival rate has been associated with early laparotomy. We report a case of acute abdomen in a patient affected by SLE, in which the diagnostic problem was solved by means of laparoscopy and the treatment was laparoscopically assisted. A 45-year-old woman with a 25-year history of SLE was admitted with abdominal pain and fever. Her physical examination revealed a painful right iliac fossa with rebound tenderness. Her WBC count was normal. Abdominal x-ray, ultrasonography, paracentesis, and peritoneal lavage did not provide a diagnosis. A diagnostic laparoscopy was performed, showing segmentary small bowel necrosis. The incision of the umbilical port site was enlarged to allow a small laparatomy, and a small bowel resection was performed. The histopathologic finding was "leucocytoclasic vasculitis, with infarction of the intestinal wall." The patient recovered uneventfully. In conclusion, this case report shows that emergency diagnostic laparoscopy is feasible and useful for acute abdomen in SLE. Currently, this diagnostic possibility could be considered the technique of choice in these cases, partly because, when necessary, it also can allow for mini-invasive treatment therapy.

The patient, a 44-year old woman with systemic lupus erythematosus, (SLE), developed infarction of the bowel and spleen after occlusion of the inferior mesenteric and splenic arteries, necessitating colectomy and splenectomy. She had had previous cerebral thromboses and a lower limb deep vein thrombosis. Histological examination of the involved vessels showed the presence of thrombus only with the total absence of any vasculitis. The patient demonstrated antibodies to phospholipid - the "lupus anticoagulant" (LA) and antibodies to cardiolipin in serum, both strongly associated with thromboses.

Histological and histochemical examinations of canine kidneys 24 hours, 7, 14 and 24 days after embolization of the renal artery with Spongostan showed that during 24 days the resorption and organization of the infarcts in the embolized kidneys and the resorption of Spongostan in the arteries were not yet completed. The intensified reactions to phosphatases, dehydrogenases, and non-specific esterase indicate a prolonged activation of cells playing a role in the resorption and organization of infarcts which may be of significance in the stimulation of immune responses. There were no inflammatory reactions in the embolized arteries.

A newborn with bilateral renal cortical necrosis and severe cerebral damage in association with a macerated stillborn twin is reported. The alterations in the kidneys and brain of the twin born alive suggest that the primary event took place before birth. Thromboplastic material and embolizing particles derived from the dead fetus may have passed the monoamnionic-monochorionic twin placenta and caused disseminated intravascular coagulation in the living twin, followed by infarction in other organ systems.

Prostatic infarction is a relatively frequent complication of adenoma of the bladder neck. Nevertheless its importance is minimal as compared with infarctions of vital organs like the brain, heart, lungs or kidneys. General and local factors may play a role in its pathogenesis. Besides other factors, it may contribute to the development of acute retention. Attention is called to the difficulties of differential diagnosis at both gross and microscopic examinations. A misdiagnosis is most frequently made in neoplastic diseases of the prostate.