PMC4295136_01
CT abdomen and pelvis with IV contrast. Findings: kidneys: both kidneys were not obstructed. A subcentimeter hypodense lesion is seen without calcification or septation in the upper pole of the left kidney. A wedge-shaped hypodense lesion is seen in the upper pole of the right kidney, which may represent a perfusion abnormality. Additional hypodense regions are seen in the mid pole of the right kidney, which may represent the sequela of a perfusion abnormality. Alternatively, these hypodense regions may represent lesions with soft tissue attenuation. In the lower pole of the right kidney, a 1.6 x 1.8 cm hypodense lesion is seen with internal enhancement.
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fig1
A computed tomographic (CT) scan (Figure 1) of the abdomen with contrast showed diverticulosis coli without surrounding inflammation.
CT abdomen and pelvis with and without contrast (renal protocol). Findings: multiple hypodense foci are present within the right kidney, on all 3 postcontrast series (blue arrows). In addition, there is intraluminal thrombus within the mid to lower pole branch of the right renal artery on the arterial phase. There is normal perfusion to the capsule surrounding these hypodense areas. Therefore, the findings are most consistent with multiple renal infarcts. The previous identified area of concern in the lower pole of the right kidney also likely represents a perfusion abnormality secondary to infarction. There are multiple low-attenuation foci within the kidneys bilaterally which are too small to characterize as well.
CRIEM2014-981409.002.jpg
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fig2
This necessitated a renal protocol CT scan (Figure 2) with and without intravenous contrast, only to confirm multiple infarcts in the right kidney with small ischemic foci in the left kidney.