Renal Artery Dissection from Blunt Abdominal Trauma: A Case Report and Literature Review

1Northwestern University Feinberg School of Medicine. Chicago. IL

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 210

Case Presentation:

This is a 43‐year‐old white man who suffered blunt abdominal wall trauma from a collision with a teammate during a Softball game. The patient initially presented to the emergency department 1 day after the injury and was diagnosed with a nondisplaced anterior left fourth rib fracture. Five days later, the patient returned to the emergency department complaining of left‐sided flank pain radiating to his groin. The patient denied any fevers, chills, dysuria, or hematuria. History was unremarkable for hypertension or known renal disease Family history was unremarkable for any renal, hematological, or collagen vascular disease. Physical exam was notable for significant hypertension (initial blood pressure 1951114) and a small healing ecchymosis over the left flank with mild tenderness to palpation. The creatinine and urinalysis were normal on laboratory examination. A triphasic CT scan was performed of the kidney that revealed abnormal enhancement involving the lower left renal pole consistent with renal infarction. One day later, CT angiography of the abdomen and pelvis showed a dissection of the left renal artery beginning 3 cm from its origin and extending into a lower‐pole regional branch. There was a less than 25% narrowing of the main renal artery but a greater than 75% occlusion of the lower‐pole arterial branch. The patient was diagnosed with a trauma‐induced renal artery dissection causing renal infarction. Vascular surgery was consulted and recommended nonoperative management with 3 weeks of anticoagulation using low‐molecular‐weight heparin. The patient's hypertension resolved after low‐dose ACE inhibitor therapy was initiated.

Discussion:

Renal artery dissection is a rare renovascular complication of blunt abdominal wall trauma. There have been roughly 20 case reports of trauma‐induced renal artery dissection described in the literature since 1941. Additional causes for dissection reported in the literature include extension from aortic dissection, spontaneous dissection, exercise/sports activities, and iatrogenic trauma. Renal artery dissection Is often accompanied by thrombus formation, which can lead to partial or complete occlusion of the main and segmental branches causing infarction. Dynamic helical CT scan is the diagnostic imaging of choice to evaluate the renal vasculature in these types of injuries. Because of the rarity of the disease and the lack of controlled clinical trials, there are no clear recommendations about the treatment for renal artery dissection. Nonoperative management is sufficient as long as the patient is hemodynamically stable and there are no clinical signs of worsening renal function. The literature has reported the use of endovascular interventions (angioplasty or stents), which have been successful in reducing the complications of renal ischemia.

Conclusions:

This case is intended to increase general awareness of this rare complication of abdominal trauma as well as present an up‐to‐date literature review.

Author Disclosure:

V. Anjan, none.

To cite this abstract:

Anjan V. Renal Artery Dissection from Blunt Abdominal Trauma: A Case Report and Literature Review. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 210. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/renal-artery-dissection-from-blunt-abdominal-trauma-a-case-report-and-literature-review/. Accessed July 21, 2019.

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