Davutoglu V, Yildirim C, Gunay N, Turkmen S
Department of Cardiology, School of Medicine, University of Gaziantep, Sahinbey Medical Center, Gaziantep, Turkey.
Emerg Med J. 2005 Aug;22(8):595-6. doi: 10.1136/emj.2003.011692.
A 31 year old man with prosthetic aortic valve replacement presented with sudden onset of colic right flank pain. Analysis of the urine revealed haematuria, and the international normalised ratio was suboptimal. The patient was misdiagnosed as having ureteral colic. On the second day, an ultrasound showed no signs of obstructive uropathy, and there was no evidence of absent function on intravenous pyelogram. Computed tomography with contrast agent was performed and revealed a right renal infarction. Renal angiography demonstrated total occlusion of the right renal artery. Fibrinolytic therapy and angioplasty were unsuccessful. To our knowledge, aortic prosthetic valve thrombus as a source of renal artery embolism mimicking renal colic has not been reported previously. This case underlines the importance of renal colic as a manifestation of renal infarction in patients with prosthetic valves and the need for a high index of suspicion of renal embolism.
一名31岁接受过主动脉瓣置换术的男性患者，突然出现右侧胁腹绞痛。尿液分析显示有血尿，国际标准化比值不理想。该患者被误诊为输尿管绞痛。第二天，超声检查未显示梗阻性尿路病的迹象，静脉肾盂造影也未发现肾功能缺失的证据。进行了增强计算机断层扫描，结果显示右肾梗死。肾血管造影显示右肾动脉完全闭塞。溶栓治疗和血管成形术均未成功。据我们所知，此前尚未有关于主动脉人工瓣膜血栓作为模仿肾绞痛的肾动脉栓塞来源的报道。该病例强调了肾绞痛作为人工瓣膜患者肾梗死表现的重要性，以及对肾栓塞保持高度怀疑的必要性。
