Chamarthi Gajapathiraju, Koratala Abhilash, Ruchi Rupam
Division of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Florida, USA.
BMJ Case Rep. 2018 Oct 21;2018:bcr-2018-226230. doi: 10.1136/bcr-2018-226230.
Spontaneous renal artery dissection is a rare clinical entity, and symptoms vary from non-specific abdominal pain to life-threatening hypertension. A 44-year-old woman with no significant medical history initially presented with symptoms suggestive of urinary tract infection which did not respond to antibiotic therapy. Imaging revealed right renal infarction resulting from focal spontaneous renal artery dissection, which was managed conservatively. CT angiography is the preferred imaging modality for the diagnosis of this condition. Treatment options include medical management of hypertension with or without anticoagulation, endovascular intervention and surgical revascularisation depending on the presentation and the extent of the vascular and renal parenchymal involvement. This case emphasises the need to have high index of suspicion for uncommon diagnoses in patients who present with common symptoms but do not respond to empiric therapy.
自发性肾动脉夹层是一种罕见的临床病症，症状从非特异性腹痛到危及生命的高血压不等。一名44岁无重大病史的女性最初出现提示尿路感染的症状，对抗生素治疗无反应。影像学检查显示局灶性自发性肾动脉夹层导致右肾梗死，对此采取了保守治疗。CT血管造影是诊断这种疾病的首选影像学检查方法。治疗方案包括使用或不使用抗凝剂进行高血压的药物治疗、血管内介入治疗以及根据临床表现和血管及肾实质受累程度进行手术血运重建。该病例强调，对于出现常见症状但对经验性治疗无反应的患者，需要高度怀疑不常见的诊断。
