Renal artery dissection as an overuse Injury

Abstract

The diagnosis of renal infarction is often convoluted due to its non-specific presentation. It can mimic disease processes as disparate as pyelonephritis, diverticulitis, or nephrolithiasis. This case is further complicated by the presence of a pelvic kidney with triplicate arterial input. It is difficult to estimate the incidence of pelvic kidneys as the numerous sources vary wildly in their estimations; however, the paucity information, in and of itself, speaks to the rarity of the condition. In this case, a 58-year-old male presents to the emergency department after experiencing sharp, sudden, and severe groin pain while swinging a golf club. The patient was noted to have an abnormally high systolic blood pressure in the 170s and hematuria, but all other initial labs and assessments were unremarkable. An initial computed tomography scan with intravenous contrast of the abdomen and pelvis showed partial necrosis of a pelvic kidney. Follow-up computed tomography angiography revealed that a dissection in one of the arteries supplying the kidney created an infarction and resultant necrosis. Vessel size, location and time between injury and diagnosis made endovascular intervention impractical. The patient was started on aspirin and Plavix, observed for 3 days and sent home.