PMC8051521_01
(a) Axial MIP CT image and (b) anterior volume-rendered 3D MPR coronal image were obtained after intravenous contrast material in arterial phase demonstrates focal thrombosis in the mid-left main renal artery (orange circle) and dissection flap (straight orange arrow in a), causing significant stenosis (orange straight arrow in b) and near-complete nonopacification of the upper segmental branch of the left renal artery for a length of approximately 3-4 mm with narrowed caliber and attenuated flow in the rest of the segmental and subsegmental branches (angled orange arrow in b), resulting in patchy cortical nonenhancement, predominantly involving the upper half and few discrete areas in the lower half of the left kidney, suggestive of infarct (orange rectangular in b), and also demonstrates normal right renal artery (red circle in a).
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fig1
Because of persistent abdominal pain despite the graded analgesia, contrast enhanced CT (CECT) of abdomen was performed (Figure 1).
(a) Coronal CT angiography image and (b) anterior volume-rendered 3D MPR coronal image were obtained after intravenous contrast material in arterial phase reveals dissection flap (straight red arrow) of the right renal artery (red circle) in (a); (b) demonstrates focal eccentric thrombosis and attenuated flow and reduced caliber of the lower lobe segmental branch (curved red arrow) and upper lobe subsegmental branch (angled red arrow), resulting in infarct (red rectangular); and also demonstrates focal thrombosis in the mid-left main renal artery and dissection flap (orange circle), causing significant stenosis (orange straight arrow) and complete thrombosis of the middle segmental branch of the left renal artery (curved orange arrow) and partial stenosis of the upper segmental branch (angled orange arrow) with new development of infarct in some part of the mid pole as well (orange rectangular).
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fig2
COVID-19 was positive. CECT abdomen (Figure 2) revealed dissection of the right renal artery with focal eccentric thrombosis and infarct of the lower pole and part of the upper pole of the right kidney.
Conventional catheter selective angiography of the left renal artery (a) reveals overall reduced perfusion in the upper half of the left kidney with a focal thrombosis in the mid-left main renal artery (orange circle) and dissection flap, causing significant stenosis (orange straight arrow); demonstrates complete thrombosis of the middle segmental branch of the left renal artery (orange curved arrow) and near-complete stenosis of the upper segmental branch (orange angled arrow); and (b) reveals reduced perfusion in the lower 1/3rd of the right kidney with focal expansion of the right renal artery (red circle) with dissection flap (red straight arrow) and with near-complete stenosis of the segmental branch (red curved arrow) supplying the lower pole and part of the upper pole.
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fig3
Conventional catheter angiography was performed (Figure 3), which confirmed the CECT findings, and endovascular management was performed sequentially.