Aim: This study reports a rare clinical case of spontaneous renal artery dissection (SRAD) presenting with multiple renal infarctions.
Background: As spontaneous renal artery dissection (SRAD) is a
rare cause of abdominal pain, bilateral dissection is an extremely rare event.
It can be defined as a dissection of the renal artery with no underlying
vascular disease, renal artery intervention, or trauma. Only approximately two
hundred cases of SRAD have been reported in the literature. The diagnosis is
often delayed due to the rarity of the disease and non-specific clinical
presentations such as flank pain, hypertension, fever, nausea, vomiting, and
hematuria, which can be often misdiagnosed as a genito-urinary infection or
gastrointestinal or bowel disease. Before 1980, the diagnosis of SRAD was
mostly confirmed via autopsy or, rarely, via angiography. At present, the
diagnosis is made using advanced imaging approaches, including computed
tomography angiography (CTA) and magnetic resonance angiography (MRA), with a
higher number of incidentally diagnosed SRADs.
Methods: The case of a 49-year-old man who was referred to our
Emergency Room with acute abdominal flank lower back pain, uncontrolled
hypertension, headache, and malaise has been reported. Laboratory tests and
radiological examinations (computed abdominal tomography and multiplanar
reconstruction) have been performed that revealed multiple infarctions and
ischemic areas with hypoperfusion in the upper middle third of the left kidney
and in a large part of middle and lower areas of the right kidney; the left
renal artery exhibited increased intimal thickening and arteritis.
Results: The multiplanar reconstruction revealed bilateral renal
artery dissection and multiple arterial infarctions disseminated throughout
both kidneys. After a clinical follow-up and hypertension retargeting, the
patient was discharged with dual antiplatelet therapy and ACE inhibitor drugs.
No lipid-lowering therapy was needed.
Conclusions: SRAD remains a diagnostic challenge as it could be
misdiagnosed or receive a delayed diagnosis due to its relative rarity and
non-specific presentation. The gold standard is enhanced computed tomography
(CT) scans, and if the diagnosis is positive, vascular multiplanar
reconstruction is generally suggested, as it can display lesions more clearly.
However, to date, a consensus has not been reached on the most appropriate
treatment. Conservative therapy, open surgery, and intravascular intervention
have been reported as treatments for SRAD. Additionally, stabilizing blood
pressure must be the primary objective not only during hospitalization but also
at discharge when planning clinical and radiological follow-ups for cases that
do not require urgent endovascular or open surgery treatment but could worsen
or relapse.
Author
(s) Details
Jirotiya V
Department of Ophthalmology, Railway Hospital Ajmer, India.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v2/5181
No comments:
Post a Comment