renal artery thrombosis

Teilinfarkt

der linken Niere in der Computertomographie.

Renal artery

occlusion (acute) • Renal infarction - Ganzer Fall bei Radiopaedia

Gaillard F, Renal infarction. Case study, Radiopaedia.org (Accessed on 23 Mar 2023) https://doi.org/10.53347/rID-9233 • CC by-nc-sa 3.0 (modified)

Renal artery

occlusion (acute) • Acute renal artery occlusion - Ganzer Fall bei Radiopaedia

Minh D, Acute renal artery occlusion. Case study, Radiopaedia.org (Accessed on 23 Mar 2023) https://doi.org/10.53347/rID-86586 • CC by-nc-sa 3.0 (modified)

Renal artery

occlusion (acute) • Renal artery thrombosis - Ganzer Fall bei Radiopaedia

Turi B, Renal artery thrombosis. Case study, Radiopaedia.org (Accessed on 23 Mar 2023) https://doi.org/10.53347/rID-24667 • CC by-nc-sa 3.0 (modified)

Renal artery

occlusion (acute) • Complete devascularisation of transplant kidney - Ganzer Fall bei Radiopaedia

Botz B, Complete devascularisation of transplant kidney. Case study, Radiopaedia.org (Accessed on 23 Mar 2023) https://doi.org/10.53347/rID-68454 • CC by-nc-sa 3.0 (modified)

Renal artery

occlusion (acute) • Renal artery thrombosis - Ganzer Fall bei Radiopaedia

Davtyan L, Renal artery thrombosis. Case study, Radiopaedia.org (Accessed on 23 Mar 2023) https://doi.org/10.53347/rID-159719 • CC by-nc-sa 3.0 (modified)

Renal

infarction: imaging findings on MDCT and CEUS.. Axial thick multiplanar reconstruction image showing lack of enhancement in the right kidney and lack of contrast filling in the right renal artery.

www.eurorad.org • CC by-nc-sa-4.0

Renal

infarction: imaging findings on MDCT and CEUS.. Coronal thick multi-planar reconstruction image showing the unenhanced part of the kidney and the renal artery thrombosis. Note the presence of a supernumerary right renal artery.

www.eurorad.org • CC by-nc-sa-4.0

Renal

infarction: imaging findings on MDCT and CEUS.. Coronal thick multi-planar reconstruction image showing the thrombosed right renal artery with the infarcted part of the kidney along with the normally opacified supernumerary artery and the respective normally enhanced renal parenchyma.

www.eurorad.org • CC by-nc-sa-4.0

Renal

infarction: imaging findings on MDCT and CEUS.. Curved multi-planar reconstruction image showing the right renal artery thrombosis.

www.eurorad.org • CC by-nc-sa-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Renal artery occlusion can happen acutely due to in-situ thrombus, embolism, or dissection. Unless immediately treated, it can lead to renal infarction .

Epidemiology

The condition is more common in the elderly, however, it may be seen in a younger age group if they have risk factors (described below). 10% of the cases have bilateral involvement.

Clinical presentation

Acute pain in the ipsilateral flank, lower abdomen or back are the usual presenting symptoms.

Pathology

Risk factors

thromboembolism (e.g. atrial fibrillation, myocardial infarction, atrial myxoma, plaque rupture, bacterial endocarditis, etc.)
trauma
aortic dissection
iatrogenic (e.g. endovascular intervention such as EVAR)
hypercoagulable disorders
sickle cell disease
cocaine abuse
congenital vascular disorders
fibromuscular dysplasia
transplant sepsis

Radiographic features

Fluoroscopy - IVP

after contrast administration there may be faint opacification (or nonopacification) of the affected kidney (with 'rim nephrogram' sign)
the affected kidney may be normal or enlarged

CT

acutely swollen and edematous kidney with perinephric stranding
patchy enhancement or non-enhancing kidney +/- 'cortical rim sign'
wedge-shaped focal infarcts if a segmental artery occlusion

Angiography (CT/conventional)

CT angiography shows the hypodense thrombus within the lumen, with possible attenuation of distal branches.

Treatment and prognosis

Acute renal artery occlusion is an emergency and requires immediate intervention. Treatment modalities include anticoagulation and thrombolysis/thrombectomy with renal artery stenting.