Abstract
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).
Keywords: Renal infarction, Atrial fibrillation, Computed tomography angiography
A 65-year-old woman with rheumatic valvular disease and atrial fibrillation presented with sudden onset of persistent right lower abdominal pain. She had no nausea, vomiting, fever, dysuria or hematuria. Physical examination showed no obvious abdominal or flank tenderness. Ultrasonography revealed slight intestinal dilation. Laboratory examinations revealed leukocytosis, mild microscopic hematuria, a serum creatine level of 1.09 mg/dL and a D-dimer level of 0.79 mg/L FEU. The pain reoccurred 2 hours later after anisodamine injection was administered and it persisted without alleviation. Right renal perfusion was significantly decreased in CTA and filling defect was disclosed in the main right renal artery (Fig. 1A–C), confirming the diagnosis of acute thrombo-embolic renal infarction.
Figure 1.
(A) Coronal plane of computed tomography angiography revealing filling defect in the main right renal artery (arrow) and significantly decreased right renal perfusion. (B) Transverse plane of CTA revealing filling defect in the main right renal artery (arrow) and significantly decreased right renal perfusion. (C) Three-dimensional reconstruction of CTA showing filling defect in the main right renal artery (arrow) and significantly decreased right renal perfusion.
Acute renal infarction (RI) is uncommon with nonspecific symptoms and frequently misdiagnosed as nephroureterolithiasis or other abdominal diseases such as pyelonephritis, diverticulitis or appendicitis.1, 2 The two major causes of RI are systemic arterial thromboembolism such as atrial fibrillation and in-situ thrombus formation due to renal artery injury, such as renal artery dissection.3 Early diagnosis is of vital importance to prevent permanent loss of renal function. The classic finding is of a wedge-shaped zone of peripheral diminished density without enhancement in CT.4 Clinical suspicion is crucial in the early diagnosis in patients with risk factors.
Conflicts of interest
The authors declare that they have no conflicts of interest.
References
- 1.Chung S.D., Yu H.J., Huang K.H. Bilateral renal infarction. Urology. 2009;73(2):273–274. doi: 10.1016/j.urology.2008.07.024. [DOI] [PubMed] [Google Scholar]
- 2.Mahamid M., Francis A., Abid A. Embolic renal infarction mimicking renal colic. Int J Nephrol Renovasc Dis. 2014;7:157–159. doi: 10.2147/IJNRD.S59745. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Saeed K. Renal infarction. Int J Nephrol Renovasc Dis. 2012;5:119–123. doi: 10.2147/IJNRD.S33768. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Eltawansy S.A., Patel S., Rao M. Acute renal infarction presenting with acute abdominal pain secondary to newly discovered atrial fibrillation: a case report and literature review. Case Rep Emerg Med. 2014;2014:981409. doi: 10.1155/2014/981409. [DOI] [PMC free article] [PubMed] [Google Scholar]