Detecting acute spontaneous isolated renal artery dissection with contrast enhanced multidetector computed tomography

Yıl 2021, Cilt: 14 Sayı: 2, 466 - 472, 01.04.2021

Esra Özgül Furkan Kaya

https://doi.org/10.31362/patd.796834

Öz

Purpose: Spontaneous isolated renal artery dissection is a very rare but threatening condition that can be difficult to diagnose early due to nonspecific symptoms. The goal of this study is to evaluate the incidence and multidetector computed tomography (MDCT) findings of this rare and important condition.
Materials and methods: We retrospectively examined the images of all patients who underwent contrast enhanced abdominal MDCT scans due to various abdominal complaints between July 2017- July 2020. 14000 contrast enhanced MDCT scans were evaluated. Only the isolated renal artery dissections without aortic involvement were included. Age, gender, symptoms, presence of thrombosis or renal parenchymal ischemia-infarct were noted. Average extension of dissection and distance from origin were measured.
Results: 8(0,054%) patients had spontaneous isolated renal artery dissection (5M, 3F, age range 43-61 years). The mean distance from origin was 3.7 cm and the average extension was 3.8 cm. 3 patients had kidney infarct with a focal area of decreased perfusion. Only 1 patient underwent digital subtraction angiography. Patients were started on an anticoagulation therapy. No surgical or interventional therapy was deemed necessary. Dissections completely disappeared in patients who could undergo follow-up MDCT.
Conclusion: Spontaneous isolated renal artery dissection is a very rare condition. The etiology is not well known. The initial symptoms are generally nonspecific such as severe upper abdomen or flank pain. There are several treatment options available such as medical, surgical or interventional managements. Early diagnose is important to prevent complications. It should be considered in patients with new-onset flank or abdominal pain.

Anahtar Kelimeler

Renal artery dissection, isolated, spontaneous, computed tomography

Kontrastlı çok dedektörlü bilgisayarlı tomografi ile akut spontan izole renal arter diseksiyonunun saptanması

Öz

Amaç: Spontan izole renal arter diseksiyonu, spesifik olmayan semptomlar nedeniyle erken teşhis edilmesi zor olabilen, çok nadir fakat tehdit edici bir durumdur. Bu çalışmanın amacı, bu nadir ve önemli durumun insidansını ve çok kesitli bilgisayarlı tomografi (ÇKBT) bulgularını değerlendirmektir.
Gereç ve Yöntem: Temmuz 2017-Temmuz 2020 tarihleri arasında çeşitli karın şikayetleri nedeniyle kontrastlı abdominal ÇKBT taraması yapılan tüm hastaların görüntülerini retrospektif olarak inceledik. 14000 kontrastlı ÇKBT görüntüsü değerlendirildi. Sadece aort tutulumu olmayan izole renal arter diseksiyonları dahil edildi. Yaş, cinsiyet, semptomlar, tromboz veya renal parankimal iskemi-enfarkt varlığı kaydedildi. Ortalama diseksiyon uzunluğu ve orijinden uzaklık ölçüldü.
Bulgular: 8 (% 0,054) hastada spontan izole renal arter diseksiyonu (5E, 3K, yaş aralığı 43-61) vardı. Orjinden ortalama uzaklık 3,7 cm ve ortalama diseke segment uzunluğu 3,8 cm idi. 3 hastada böbrekte parankimal enfarkt vardı. Sadece 1 hastaya dijital substraksiyon anjiyografisi yapıldı. Hastalara antikoagülan tedavi başlandı. Cerrahi veya girişimsel tedaviye gerek görülmedi. ÇKBT takibi yapılabilen hastalarda diseksiyonlar tamamen kayboldu.
Sonuç: Spontan izole renal arter diseksiyonu çok nadir görülen bir durumdur. Etiyoloji iyi bilinmemektedir. İlk semptomlar genellikle nonspesifik olup şiddetli karın veya yan ağrısıdır. Tıbbi, cerrahi veya girişimsel yönetimler gibi çeşitli tedavi seçenekleri mevcuttur. Erken teşhis, komplikasyonları önlemek için önemlidir. Yeni başlayan böğür veya karın ağrısı olan hastalarda düşünülmelidir.

Anahtar Kelimeler

Renal arter diseksiyonu, izole, spontan, bilgisayarlı tomografi, nadir

Kaynakça

• Tandon G, Sukhija R. Isolated spontaneous renal artery dissection: a case report and review. Int J Angiol. 2012 Jun;21(2):99-102. https://doi.org/10.1055/s-0032-1315623
• Regmi MR, Carbrey SA, Parajuli P, Garcia OEL and Bhattarai M. A Rare Case of Isolated and Idiopathic Spontaneous Renal Artery Dissection in a Female Patient on Multiple Medications. Cureus. 2019 Sep 26;11(9):e5770. https://doi.org/10.7759/cureus.5770
• Hasnain H, Afif N, Nicholas SB. Case Report: 52-Year-Old Male with Right Upper Quadrant Abdominal Pain. J Clin Nephrol Ren Care. 2018;4(2). https://doi.org/10.23937/2572-3286.1510040
• Ramamoorthy SL, Vasquez JC, Taft PM, McGinn RF, Hye RJ. Nonoperative management of acute spontaneous renal artery dissection. Ann Vasc Surg. 2002 Mar;16(2):157-162. https://doi.org/10.1007/s10016-001-0154-0
• García-Familiar A, Ortiz-Gutiérrez F, De Blas-Bravo M, Sánchez-Abuín J, Rodríguez Sáenz de Buruaga V, Egaña-Barrenechea JM. Isolated spontaneous renal artery dissection: endovascular management. Ann Vasc Surg. 2014 May;28(4):1034. https://doi.org/10.1016/j.avsg.2013.06.043
• Herd JA. Cardiovascular response to stress in man. Annu Rev Physiol 1984;46: 177-185. https://doi.org/10.1146/annurev.ph.46.030184.001141
• Mirsai V, Peyromaure M, Poiree S, Marteau V, Laurian C. Spontaneous dissection of branch renal artery - is conservative management safe and effective? J Urol 2006;176: 2125-2129. https://doi.org/10.1016/j.juro.2006.07.017
• Müller BT, Reiher L, Pfeiffer T, et al. Surgical treatment of renal artery dissection in 25 patients:indications and results. JVascSurg 2003;37(4):761-768. https://doi.org/10.1067/mva.2003.171
• Van Rooden CJ, van Baalen JM, van Bockel JH. Spontaneous dissection of renal artery: long-term results of extracorporeal reconstruction and autotransplantation1. J Vasc Surg 2003;38(1):116-122. https://doi.org/10.1016/s0741-5214(02)75453-0
• Pellerin O, Garçon P, Beyssen B, et al. Spontaneous renal artery dissection: long-term outcomes after endovascular stent placement. J Vasc Interv Radiol 2009;20(8):1024-1030. https://doi.org/10.1016/j.jvir.2009.04.069
• Mudrick D, Arepally A, Geschwind JF, Ronsivalle JA, Lund GB, Scheel P. Spontaneous renal artery dissection: treatment with coil embolization. J Vasc Interv Radiol 2003;14(4):497-500. https://doi.org/10.1097/01.rvi.0000064845.87207.70