Cortical rim sign and acute renal infarction

• Published in: Canadian Medical Association journal (CMAJ) 2010-05, Vol.182 (8), p.E313-E313
• Main Authors: Hsiao, Po-Jen, Wu, Tsung-Jui, Lin, Shih-Hua
• Format: Article
• Language: English
• Subjects: Abdomen; Acute Disease; Adult; Anticoagulants - therapeutic use; Care and treatment; Diagnosis; Flank Pain - etiology; Heparin - therapeutic use; Humans; Infarction - diagnostic imaging; Kidney - blood supply; Kidney - diagnostic imaging; Kidney diseases; Male; Pain; Practice; Renal Artery - diagnostic imaging; Renal artery obstruction; Renal Artery Obstruction - diagnostic imaging; Renal Artery Obstruction - drug therapy; Renal Artery Obstruction - etiology; Risk factors; Thrombosis - diagnostic imaging; Thrombosis - drug therapy; Tomography, X-Ray Computed; Urokinase-Type Plasminogen Activator - therapeutic use
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.091110

Acute renal infarction can be cardiogenic or noncardiogenic in origin. In patients with noncardiogenic acute renal infarction who have no apparent risk factors (e.g., thromboembolism, coagulation dysfunction, hematologic diseases) the cause often remains elusive. These instances are labelled as idiopathic, as in our patient.1,2 The diagnosis of acute renal infarction is often delayed because of a low index of suspicion by physicians. Clinical features include unexplained acute pain in the flank or abdomen, and elevated serum lactate dehydrogenase levels, even in the absence of heart disease. Contrast-enhanced CT helps to facilitate a rapid diagnosis. The cortical rim sign, seen in about 50% of acute renal infarctions,3 is relatively specific to this condition and be - lieved to result from intact renal collateral circulation following a vascular insult, such as renal artery thrombosis or embolization, renal artery dissection or renal trauma. Therapeutic guidelines for acute renal infarction are not well established.