PMC4286817_01
43-year-old woman presented with recurrent enterocutaneous fistula and synchronous acute pulmonary embolism, and was subsequently noted to have acquired, transient, rotated right kidney. (a) Axial contrast-enhanced computed tomography (CECT) scan of the abdomen at presentation (Day 0) shows rotation of the enlarged right kidney (arrow) around its short axis into the horizontal plane. (b) Coronal CECT scan of the abdomen at Day 0 shows hepatomegaly (double head arrow) with rotation of the enlarged right kidney (arrow head) around its short axis into the horizontal plane. (c) Axial CECT scan of the chest at Day 0 shows enlarged main pulmonary artery (double head arrow) measuring 34 mm. (d) Axial CECT scan of the chest at Day 0 shows segmental embolus (arrow) in the anterior branch of the right upper lobe pulmonary artery. (e) Axial CECT scan of the chest at Day 0 shows dilated right ventricle (double head arrow) with RV/LV ratio of 1.8. (f) Axial CECT scan of the liver at day 0 shows reflux of the contrast material into the inferior vena cava (arrow) and hepatic veins (arrow head). (g) Axial CECT scan of the abdomen 45 days before presentation (day -45) shows normal orientation of the normal-sized right kidney (arrow). (h) Coronal CECT scan of the abdomen at Day -45 shows normal orientation of the normal-sized right kidney (arrow head) and normal liver (double head arrow) size.
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F1
CT scan of the abdomen and pelvis on admission demonstrated rotation and mild inferior displacement of the right kidney, with the long axis of the kidney lying in the horizontal plane [Figure 1a and b]. CT pulmonary angiography performed synchronously for syncope and pulmonary decompensation demonstrated a segmental pulmonary embolism and right heart strain, including reflux of contrast material into the inferior vena cava, interventricular septal bowing, enlarged main pulmonary artery (34 mm), and right ventricular dilatation (RV/LV ratio of 1.8) [Figure 1c-f]. The most recent CT scan done 45 days prior to this admission is shown in Figure 1g and h.
43-year-old woman presented with recurrent enterocutaneous fistula and synchronous acute pulmonary embolism, and was subsequently noted to have acquired, transient, rotated right kidney. (a) Axial contrast-enhanced computed tomography (CECT) scan of the abdomen 10 days after presentation (Day 10) shows return of the right kidney (arrow) to its normal axis. (b) Axial CECT scan of the chest at Day 10 shows normal-sized main pulmonary artery (double head arrow) measuring 25 mm. (c) Coronal CECT scan of the abdomen at Day 10 shows improvement in hepatomegaly (double head arrow) with return of the right kidney (arrow head) to its normal axis. (d) CECT scan of the chest at Day 10 shows normal-sized right ventricle (double head arrow) with RV/LV ratio of 0.86.
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F2
Follow-up imaging done after 10 days demonstrated normalization of the right kidney axis, position, and size, as well as decrease in hepatomegaly [Figure 2a and b]. Repeat CT pulmonary angiogram [Figure 2c and d] performed 10 days after presentation showed normalization of the thoracic changes including normal size of main pulmonary artery (25 mm) and normal right ventricular size (RV/LV ratio of 0.86).
43-year-old woman presented with recurrent enterocutaneous fistula and synchronous acute pulmonary embolism, and was subsequently noted to have acquired, transient, rotated right kidney. Liver and kidney volumes were calculated 45 days before presentation (Day -45), at presentation (Day 0), and 10 days after presentation (Day 10). The volume of the liver was approximately 1390, 2340, and 1944 cm3 on Days -45, 0, and 10, respectively. The corresponding values for the right kidney were 141, 168, and 142 cm3, respectively.
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F3
Calculation of liver and kidney volumes from CT scans done 45 days before presentation, on the day of admission, and 10 days following admission, using the method described by Dello et al., is presented in Figure 3.