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Antiphospholipid syndrome (APLS) is a systemic autoimmune disorder characterized by venous or arterial thrombosis in the presence of persistent laboratory evidence of antiphospholipid antibodies. We report a case of a previously healthy, 14-year-old boy, who presented with abdominal pain and headache for one day. Magnetic resonance imaging of the brain revealed sinus venous thrombosis and multiple areas of arterial and venous infarction. Computed tomography of the abdomen showed smaller right kidney with multiple wedge-shaped non-enhancing cortical areas of renal infarction. A diagnosis of APLS was made following demonstration of antibodies to cardiolipin and beta-2 glycoprotein, and the child was managed conservatively with antihypertensive agents, anticoagulation, and immunosuppressants. Follow-up imaging after one year showed resolution of cerebral thrombosis and improvement in renal functions.

Tc-99m dimercaptosuccinic acid (DMSA) renal cortical scintigraphy (RCS) of a 46-year-old man with abdominal and right flank pain who had history of a tendency toward thrombosis revealed extensive renal parenchymal changes secondary to renal infarction and a small size defect in the right kidney in addition to the patient's prior computed tomography results. The patient had Coumadin treatment. Two months later, he was referred to the hospital with the same symptoms. DMSA RCS established that the small defect in the right kidney had enlarged; other scarred areas persisted. This case indicates the value of DMSA RCS for early diagnosis, follow-up of acute/recurrent renal parenchymal scarring in patients with thrombophilia.

Of the several complications known to develop after cardiac catheterization, simultaneous acute renal infarction and renal subcapsular hematoma is rare. Here, the authors report a case of acute renal infarction with subcapsular hematoma that developed 4 hours after cardiac catheterization.

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 a rare case of bilateral segmental renal infarction secondary to FMD in a young male patient. His initial presentation with loin pain and pyrexia resulted in a delay in the definitive diagnosis of FMD. He was successfully treated with bilateral balloon angioplasty. The delayed diagnosis in this patient until the condition had progressed to bilateral renal infarcts highlights the need for prompt investigation and diagnosis of suspected cases of FMD.

若年者における鈍的腹部外傷による腎梗塞を経験したので報告する. 症例は13歳の男児, スキーにて転倒し腹部を強打し, 翌日当科紹介された. 体温38.6℃, 左側腹部に強い圧痛と筋性防御を認めたが, 皮下出血, 外傷は認めなかった. 血液検査所見では白血球増加, ALT, LDH, クレアチニンの上昇, 尿潜血, 蛋白尿を認めた. 入院時の単純CTにて異常を認めず経過観察されたが, 第2病日, 悪寒を伴う発熱あり, 造影CT施行したところ, 左腎動脈の血流途絶がみられ左腎は全く造影されず, 腎動脈内膜損傷等の機序による左腎梗塞と診断した. 保存的治療により軽快退院したが, 6カ月後の腹部造影CTでは左腎の著明な萎縮がみられ, 無機能腎となったものと思われた. 外傷性腎梗塞は稀な病態ではあるが, 造影CTによる早期診断と, 早期の血栓溶解療法または血行再建を考慮する必要がある.

Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

Flank pain is a common complaint in the emergency department, and the most frequent cause of flank pain is urolithiasis. Spontaneous renal artery dissection and renal artery thrombosis are rare causes of abdominal pain which can result in renal parenchymal injury. They are mostly difficult to diagnose and treat in the emergency setting. The present report describes 2 patients admitted to the emergency department because of acute flank pain who were diagnosed with renal infarction.

Background: Renal aspergillosis is a rare infection that usually occurs in persons with a predisposition for this condition. Its differential diagnosis includes primary and metastatic renal malignancies, pyelonephritis and secondary abscess formation, granulomatous disorders, and renal infarction. We aim to stress the role of multimodality imaging and percutaneous biopsy in the diagnosis of this condition. Case Report: We present diffusion weighted imaging (DWI) and positron emission tomography-computed tomography (PET-CT) findings in addition to conventional imaging modalities in a 55-year-old man with secondary renal aspergilloma. Conclusion: Radiological imaging methods are an integral part of diagnostic workup for renal aspergillosis. A definitive diagnosis is made by histopathological and/or microbiological examination of the material obtained via percutaneous biopsy under guidance of imaging methods.

Spontaneous renal artery dissection is a rare but important cause of flank pain. We report a case of isolated spontaneous renal artery dissection in 56-year-old man complicated by renal infarction presented with flank pain. Doppler study pointed towards vascular pathology. Computed tomography (CT) angiography was used to make final diagnosis which demonstrated intimal flap in main renal artery with renal infarction.

Epigastric pain is a manifestation of several medical and surgical conditions. However, when persistent epigastric pain is associated with microscopic or frank haematuria and elevated lactate dehydrogenase (LDH), especially in patients with increased risk of thromboembolic events, acute renal infarction (ARI) should be considered. We report the case of a 77-year-old male patient who presented with sudden persistent epigastric pain and elevated LDH who was found to have atrial fibrillation. The patient was diagnosed with ARI. ARI is not usually a typical differential diagnosis in patients with persistent epigastric pain and elevated LDH in whom the risk of thromboembolic events is high. Thus, physicians should perform a contrast-enhanced CT scan as early as possible to rule out or confirm renal infarction.

Acute renal infarction is a rare clinical entity most commonly occurring as a result of a thromboembolic event in patients with predisposing risk factors. Its non-specific presentation can lead to delayed or missed diagnosis. However, modern imaging technology has allowed for the diagnosis of renal infarction to be made earlier in its clinical course. Due to its rare nature, treatment guidelines do not exist. We report a case of acute renal infarction identified on computed tomography scan in a patient with no known predisposing factors to thromboembolism that was treated through suction thrombectomy.

Horseshoe kidney is a common urology anomaly, while its association with infrarenal abdominal aortic aneurysm represents a very rare condition. Surgical approach remains controversial however, we believe that the left retroperitoneal approach should be preferred in order to avoid isthmus resection with any subsequent renal infarction, urinary tract damage and to facilitate renal arteries reimplantation, when required. We present a case of voluminous infrarenal abdominal aortic aneurysm associated with horseshoe kidney, successfully treated through a left retroperitoneal approach on the retro-renal space.

Acute renal infarction presents in a similar clinical picture to that of a renal stone. We report a 55-year-old Saudi female, known to have atrial fibrillation secondary to mitral stenosis due to rheumatic heart disease. She presented with a two day history of right flank pain that was treated initially as a renal stone. Further investigations confirmed her as a case of renal infarction. Renal infarction is under-diagnosed because the similarity of its presentation to renal stone. Renal infarction should be considered in the differential diagnosis of loin pain, particularly in a patient with atrial fibrillation.

Renal artery thrombosis is a threatening clinical diagnosis, in which renal infarction may occur. Often misdiagnosed, for mimicking other common diseases, it should be considered in persistent flank pain to improve care and reduce morbidity. We review a case of a healthy, 57 year-old woman with renal artery thrombosis mimicking pyelonephritis and renal calculus obstruction, highlighting features of this clinical condition. An accurate diagnosis is essential for optimal management and prompts treatment, which still remains to be defined.

We experienced two cases of renal infarction with atrial fibrillation who presented with acute abdominal pain. On initial urinalysis, both patients showed no hematuria, but the plasma lactate dehydrogenase level was markedly elevated with little or no rise in plasma transaminases. Their diagnosis was confirmed by contrast-enhanced CT of the abdomen on the second and third days of the crisis. We immediately initiated anticoagulant therapy, resulting in successful prevention of new embolism. Contrast-enhanced CT should be considered if abdominal symptoms develop in patients with atrial fibrillation. Renal infarction could be diagnosed in the early course, even in cases with incomplete occlusion of the renal arteries and normal renal function. (Hypertens Res 2004; 27: 523-526)

Renal infarction is frequently misdiagnosed as other common diseases, such as urolithiasis, pyelonephritis, or intra-abdominal lesions, because of its rareness and nonspecific clinical presentation and laboratory findings. However, delayed diagnosis is associated with persistent clinical symptoms, risk of renal impairment, and even death. We report a 43-year-old man who was diagnosed with acute appendicitis initially as a result of right lower abdominal pain/tenderness with leukocytosis. Contrast enhanced computed tomography was done because of refractory pain and infarction of the lower pole of the right kidney infarction was found. Renal infarction should be included in the differential diagnosis of abdominal/flank pain, especially in those with risk factors such as atrial fibrillation, valvular heart disease and previous thromboembolic events.

Learning points for clinicians A 54-year-old Caucasian male non-smoker presented to the Emergency Department with severe left loin pain of sudden onset for the last 3 h. He reported frequent migraines for the last 20 years, for which he had been taking occasional ergotamine 1 mg/caffeine tablets, obtained over-the-counter overseas. The migraines had worsened recently, attributed to stress at work and therefore he had been taking the ergotamine almost daily. On the day prior to admission, he had taken three tablets over 24 h, and reported increasingly severe episodes of loin pain occurring about 1 h after administration of the second …

A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA).

Sir,Atrial fibrillation (Af) is an important risk factor for cerebral infarction and peripheral arterial thromboembolism.1,2 Acute renal infarction (RI) induced by Af was reported to occur in only ...

Purpose: To analyze the incidence and etiology of renal infarctions following endovascular abdominal aortic aneurysm (AAA) repair detected on computed tomography (CT) and determine any association with infrarenal versus suprarenal fixation. Methods: Between August 1994 and October 2001, 663 patients (604 men; mean age 68.5 years, range 40–98) underwent endovascular AAA repair with predominately bifurcated (505, 77%) stent-grafts. About a third (202, 30%) of the devices were deployed in a suprarenal position. Contrast-enhanced CT scans were performed on days 10, 90, and 365 after operation and then annually. Two radiologists blinded to procedural details compared the preoperative and postoperative scans to identify renal infarctions from inadvertent renal artery occlusion by the endograft. Only patients with inadvertent infarctions were analyzed relative to endograft fixation position and stent-graft type. Results: Mean follow-up was 37 months (range 0.1–75). Overall renal infarction rate was 11.9% (n=79); 23 (3.4%) patients suffered from limited, segmental infarction due to intentional covering of preoperatively diagnosed accessory renal arteries. Unintentional renal ischemia was identified in 56 (8.5%) patients. In this subgroup, 39 (19%) were observed in the 202 patients with suprarenal fixation versus 17 (3.7%) in the 461 stent-grafts positioned infrarenally (RR 3.35, 95% CI 2.20 to 5.04, p < 0.00001). There was a significant correlation between the incidence of infarction and the device type (14.3% for modular grafts versus 5.6% for unibody designs, p = 0.0002). Seventeen (2.6%) patients suffered from unilateral kidney loss, with dialysis required in 2 cases. Creatinine and urea showed no significant postoperative elevation in the overall patient population, but both levels were significantly (p < 0.02) elevated in patients with complete unilateral renal infarcts. Conclusions: Transrenal fixation of aortic endografts had a 3-fold higher risk for renal infarction in this large patient population. There is no significant difference for specific endografts, but modular designs were associated with a higher rate of renal infarction. The need to occlude preoperatively diagnosed accessory renal arteries with an endograft should be considered a contraindication for current available devices.

Acute renal artery thromboembolism (ARAT), a rare event in native kidneys, potentially result in severe renal injury if it is not appropriately managed. The optimal therapy still remains controversial today even though various methods of managements for ARTA were applied in these decades including surgical intervention and medical approach such as thrombolytic therapy. Recombinant tissue plasminogen activator (rt-PA) reveals a better bioavailability and lower incidence of adverse effects and it has been widely used to treat a number of clinical conditions but only very few cases have been reported where rt-PA was used to treat ARAT. We described a case of ARAT, which was successfully treated by the administration of rt-PA via intra-arterial infusion within a period of 60 min without residual renal impairment. It may be a useful choice for ARAT and renal infarction sufferers.

Renal artery aneurysm is a relatively uncommon condition that is usually detected incidentally after an imaging workup. A renal artery aneurysm is defined as a dilated segment of renal artery that exceeds twice the diameter of a normal renal artery. Symptomatic renal artery aneurysms can cause hypertension, pain, hematuria, and renal infarction. Asymptomatic renal artery aneurysms may seem benign, but the potential for rupture and fistulization increases with size. In this report we describe the treatment strategy of saccular renal artey aneurysm in a 47-year-old man who presented with flank pain.

Renal infarction is a rare clinical problem and it is frequently misdiagnosed because of the nonspecificity of its symptoms. We present two cases of renal infarction with two different etiologies. The first case was a 43-year-old male who attended the emergency department for pain in the left flank. A contrast-enhanced abdominal computed tomography scan was performed due to the persistent pain, and the segmental renal infarction was detected. The second case, a 6-year-old girl, was hospitalized due to falling from a height of 8 meters. Traumatic renal infarction was detected in the abdominal computed tomography scan which was performed during the assessment for multiple traumas. Both patients were followed-up conservatively and discharged from the hospital without any renal complications. The diagnosis of renal infarction is generally based on the clinical suspicion. Emergency physicians should keep renal infarction in mind during the management of the patients with abdominal, back or flank pain., Renal infarction is a rare clinical problem and it is frequently misdiagnosed because of the nonspecificity of its symptoms. We present two cases of renal infarction with two different etiologies. The first case was a 43-year-old male who attended the emergency department for pain in the left flank. A contrast-enhanced abdominal computed tomography scan was performed due to the persistent pain, and the segmental renal infarction was detected. The second case, a 6-year-old girl, was hospitalized due to falling from a height of 8 meters. Traumatic renal infarction was detected in the abdominal computed tomography scan which was performed during the assessment for multiple traumas. Both patients were followed-up conservatively and discharged from the hospital without any renal complications. The diagnosis of renal infarction is generally based on the clinical suspicion. Emergency physicians should keep renal infarction in mind during the management of the patients with abdominal, back or flank pain

Background Coral reef aorta (CRA) is a rare, potential lethal disease of the visceral aorta as it can cause visceral and renal infarction. Various surgical approaches have been proposed for the CRA treatment. The purpose of this article is to report different extensive extra-anatomic CRA treatment modalities tailored on the patients' clinical and anatomic presentation. Methods From April 2006 to October 2012, 4 symptomatic patients with extensive CRA were treated at our department. Extra-anatomic aortic revascularization with selective visceral vessels clamping was performed in all cases. Results Technical success was 100%. No perioperative death was registered. All patients remained asymptomatic during the follow-up period (62, 49, 25, and 94 months, respectively), with bypasses and target vessels patency. Conclusions The extra-anatomic bypass with selective visceral vessels clamping reduces the aortic occlusion time and the risk of organ ischemia. All approaches available should be considered on a case-by-case basis and in high-volume centers.

A sentinel loop observed on plain radiography is a known sign of localized paralytic ileus that is primarily associated with acute pancreatitis, acute cholecystitis, and acute appendicitis. Here, we report a case of acute renal infarction (RI) complicated by a sentinel loop. A 58-year-old man with atrial fibrillation (AF) was hospitalized for paralytic ileus and was subsequently diagnosed with acute RI caused by embolism from the heart. Reports of sentinel loop signs on radiographs as a complication of acute RI are not available in previous English literature. For early diagnosis of acute RI and initiation of therapy to recover the function of the affected kidney and to prevent repeated thromboembolic events, it is important to recognize that a sentinel loop can be seen in acute RI as well as in other intra-abdominal inflammatory diseases.

Abuse of anabolic-androgenic steroids (AAS) is a widespread problem throughout Western society. The secretive nature of AAS makes it difficult to study the potential consequences with recognised scien