PMC3173832_01
Contrast-enhanced CT scan of the abdomen demonstrates (a) left renal artery thrombus (arrow) and (b) heterogenous cortical enhancement and wedge shaped cortical hypodensities in the lower pole of the left kidney.
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F1
A contrast-enhanced abdominal computed tomography (CT) scan demonstrated multiple wedge-shaped low-attenuation areas, involving large proportion of the left kidney, associated with a filling defect in the left main renal artery [Figure 1].
Selective left renal angiogram shows a proximal high-grade stenosis (white arrow) with a thrombus in the post stenotic segment of the renal artery (black arrow) and several emboli in the inferior segmental renal branches (arrowheads).
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F2
Selective renal angiography demonstrated a thrombus immediately distal to the stenosis [Figure 2].
(a): After stent placement the renal artery is widely patent with improved blood flow in the renal artery. Stent placement had resulted in distal embolization of thrombus into the inferior renal branch (arrow). (b) Renal angiogram following 22 hours of thrombolysis showed small residual emboli in the inferior branches (arrowheads) with significant improvement of the cortical perfusion.
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F3
Renal angiogram after stent placement showed a widely patent main renal artery and distal embolization of the thrombus into the inferior segmental branch [Figure 3a]. After 22 hours of thrombolysis, a repeat angiogram revealed near complete resolution of the segmental renal artery thrombus [Figure 3b].
Renal isotope scan one month later revealed slightly reduced cortical uptake in the lower pole of the left kidney with borderline reduced split renal function of 38%.
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F4
One month later, 99mTc MAG3 renal scintigraphy showed slightly reduced renal uptake in the lower pole of the left kidney and a borderline decreased split renal function at 38% [Figure 4].