Persistent Wedge-Shaped Low-Density Lesions on Computed Tomography of the Kidneys without Infarction

Abstract

A patient with acute lymphoblastic leukemia, who developed acute renal failure, was imaged by computed tomography (CT). Persistent wedge-shaped areas of low attenuation in the kidneys were shown by sequential scans but no areas of infarction were found at autopsy. This case suggests that a wedge-shaped low-density lesion on CT may occur not only in infarcted areas, but also in areas where patchy vasoconstriction occurs.

Wedge-Shaped Low-Density Lesion on Sonography of the Kidney in Advanced Cirrhotic Patient

“…Wedge-shaped lesion on computed tomography which was regarded as indicative of patchy vasoconstric tion, has been reported in the patients with acute renal failure due to nonsteroidal antipyretic drug [3], rhabdomyolysis [4] or hypotension [5]. We regarded wedge-shaped lesion of renal sonography in our case as the same kind of nature in origin as those of previous reports and consid ered its participation in occurring of ATN.…”

Renal Infarction in a Patient without Underlying Diseases

“…Acute renal failure with Hank pain and/or patchy renal vasoconstric tion associated with NSAIDs have been re ported [2). We also reported acute renal fail ure due to patchy vasoconstriction associat ed with rhabdomyolysis [3], hypotension [4], and analgesics used in a cirrhotic patient [5], Diclofenac in this patient appears to have induced acute renal failure which resulted in an increase in plasma volume, leading to generalized edema and high blood pressure, probably associated with the development of patchy renal vasoconstriction. It is suggested by the narrowing of the renal arterial branches observed by renal angiography without abrupt cutoff signs.…”

Bone Scintigraphy in Acute Renal Failure with Severe Loin Pain and Patchy Renal Vasoconstriction

“…On the enhanced CT of the kidney in our patients, patchy low-density areas or diffuse enhancement immediately af ter radiocontrast injection changed to the patchy wedgeshaped enhancement 24 or 48 h later, which subsequently disappeared 72 h later. These findings suggest that low renal blood and glomerular filtration in the patchy areas gradually increased the amount of ultrafiltrate containing contrast medium or contrast medium was retained within the tubules and was regarded to be associated with transient preglomerular vasoconstriction [15,16] or tubular obstruc tion [17]. The wedge-shaped lesions suggest that vasocon striction on the level of interlobar or arcuate arteries in the kidney results in patchy areas of ischemic damage [16,18].…”