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Fibromuscular Dysplasia, Renal Infarct

Graham JWG - MedPix

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Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Fibromuscular Dysplasia, Renal Infarct

History: 38 year old healthy male with past medical history significant only for recent onset hypertension. Presented to the Emergency Department with acute onset of left flank pain.

Findings: CT KUB was performed to evaluate for suspected renal stones. CT evaluation demonstrated normal appearing kidneys, with no evidence of renal obstruction or urolithiasis. A recently passed stone was considered, and the patient discharged home. The patient returned 4 days later with continued and worsening left flank pain. There was flank tenderness on physical exam. UA showed moderate blood. CBC was normal, including a normal white count. CT KUB was again performed. There was no urolithiasis or hydronephrosis, but there was interval development of significant perinephric stranding. Given lack of other clinical findings of pyelonephritis, a renal mass could not be excluded, and a contrast examination was ordered. Contrast CT demonstrated a wedge shaped area of non-perfusion in the upper outer aspect of the left kidney. A renal infarct was felt to be the most likely etiology, though there was no history to suggest a source. Further evaluation included echocardiography, which was negative. Laboratory analysis for abnormal clotting factors was negative. As fibromuscular dysplasia and vasculitis were also considered, renal MRA performed. This again demonstrated the area of non-perfusion in the left kidney, but also showed irregular narrowing and dilation of both renal arteries, highly suggest of fibromuscular dysplasia. The patient was treated for symptoms and placed on Plavix. Outpatient angiography was then performed, confirming findings of FMD previously seen on MR

Ddx: Initial appearance of the kidney: Pyelonephritis Renal infarct Renal neoplasm (RCC, AML), possibly with acute hemorrhage For renal artery changes: Atherosclerotic disease Fibromuscular dysplasia Vasculitis Trauma

Dxhow: Imaging to include CT, MR, and Angiography

Exam: Labs were normal except for a small amount of blood in the urine

No MeSH data available.


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Fibromuscular Dysplasia, Renal Infarct

Graham JWG - MedPix

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1366&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Madigan Army Medical Center

ABSTRACT

Diagnosis: Fibromuscular Dysplasia, Renal Infarct

History: 38 year old healthy male with past medical history significant only for recent onset hypertension. Presented to the Emergency Department with acute onset of left flank pain.

Findings: CT KUB was performed to evaluate for suspected renal stones. CT evaluation demonstrated normal appearing kidneys, with no evidence of renal obstruction or urolithiasis. A recently passed stone was considered, and the patient discharged home. The patient returned 4 days later with continued and worsening left flank pain. There was flank tenderness on physical exam. UA showed moderate blood. CBC was normal, including a normal white count. CT KUB was again performed. There was no urolithiasis or hydronephrosis, but there was interval development of significant perinephric stranding. Given lack of other clinical findings of pyelonephritis, a renal mass could not be excluded, and a contrast examination was ordered. Contrast CT demonstrated a wedge shaped area of non-perfusion in the upper outer aspect of the left kidney. A renal infarct was felt to be the most likely etiology, though there was no history to suggest a source. Further evaluation included echocardiography, which was negative. Laboratory analysis for abnormal clotting factors was negative. As fibromuscular dysplasia and vasculitis were also considered, renal MRA performed. This again demonstrated the area of non-perfusion in the left kidney, but also showed irregular narrowing and dilation of both renal arteries, highly suggest of fibromuscular dysplasia. The patient was treated for symptoms and placed on Plavix. Outpatient angiography was then performed, confirming findings of FMD previously seen on MR

Ddx: Initial appearance of the kidney: Pyelonephritis Renal infarct Renal neoplasm (RCC, AML), possibly with acute hemorrhage For renal artery changes: Atherosclerotic disease Fibromuscular dysplasia Vasculitis Trauma

Dxhow: Imaging to include CT, MR, and Angiography

Exam: Labs were normal except for a small amount of blood in the urine

No MeSH data available.