Iqbal Fahad M, Goparaju Madhavi, Yemme Soumya, Lewis Bruce E
Department of Internal Medicine, St Joseph Hospital, 2900 N Lake Shore Drive, Chicago, IL 60657, USA.
Angiology. 2009 Feb-Mar;60(1):122-6. doi: 10.1177/0003319707310278.
A 38-year-old, previously healthy man presented with flank pain after competing in a marathon. Initial laboratory tests and urinalysis were essentially normal. Both contrast enhanced-computed tomography and magnetic resonance angiography showed an infarcted region of the left lower kidney without renal artery dissection. Thromboembolism was suspected, but further testing was negative. The diagnosis of renal artery dissection was established by angiogram, showing dissection of the segmental branch. The patient remained normotensive, maintained normal renal function, and had resolution of pain symptoms prior to discharge. On the basis of our experience and review of the literature, renal artery dissection occurs in otherwise healthy men and often goes undiagnosed. The management strategy tends to be conservative unless the patient develops progressive decline in renal function or worsening hypertension, with an excellent prognosis. This case also shows the importance of discussing the pros and cons of extreme physical exertion with all patients.
一名38岁、既往健康的男性在参加马拉松比赛后出现侧腹痛。初始实验室检查和尿液分析基本正常。增强计算机断层扫描和磁共振血管造影均显示左肾下极有梗死区域，无肾动脉夹层。怀疑有血栓栓塞，但进一步检查结果为阴性。血管造影确诊为肾动脉夹层，显示节段性分支夹层。患者血压一直正常，肾功能维持正常，出院前疼痛症状缓解。根据我们的经验和文献回顾，肾动脉夹层发生于其他方面健康的男性，且常未被诊断出来。除非患者出现肾功能进行性下降或高血压恶化，否则治疗策略倾向于保守，预后良好。该病例还显示了与所有患者讨论极限体育锻炼利弊的重要性。
