Images in emergency medicine
Persistent flank pain without active urinary sediments
Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
Correspondence to:
Correspondence to:
S-J Chen
Department of Emergency Medicine, Tri-Service General Hospital, 325, Sec 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China;doc50014@ndmctsgh.edu.tw
Accepted 25 April 2006
| The first 150 words of the full text of this article appear below. |
A 45-year-old man presented to the emergency department because of persistent steady flank pain for 18 h. He denied having any systemic illness or trauma. On arrival, his vital signs were normal. Physical examination showed knocking tenderness over his left flank. His laboratory results disclosed leucocytosis (white cells 10 700/l), mildly raised serum creatinine (1.1 mg/dl) and aspartate aminotransferase (78 U/l). The urinary analysis showed absence of pyuria or haematuria. Ultrasonography of the kidneys showed no hydronephrosis, but a hypoechoic area over the lower portion of the left kidney. Contrast-enhanced computed tomography confirmed the diagnosis of acute renal infarction (fig 1A
, arrow). Angiography of the left renal artery showed several segmental thrombi (arrows) in the left main renal artery (fig 1B). Intra-artery thrombolytic treatment with urokinase was carried out. Follow-up angiography showed patency of the affected artery. On follow-up at 2 months his serum creatinine was normal, but
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