Kontrastlı çok dedektörlü bilgisayarlı tomografi ile akut spontan izole renal arter diseksiyonunun saptanması

Amaç: Spontan izole renal arter diseksiyonu, spesifik olmayan semptomlar nedeniyle erken teşhis edilmesi zor olabilen, çok nadir fakat tehdit edici bir durumdur. Bu çalışmanın amacı, bu nadir ve önemli durumun insidansını ve çok kesitli bilgisayarlı tomografi (ÇKBT) bulgularını değerlendirmektir. Gereç ve Yöntem: Temmuz 2017-Temmuz 2020 tarihleri arasında çeşitli karın şikayetleri nedeniyle kontrastlı abdominal ÇKBT taraması yapılan tüm hastaların görüntülerini retrospektif olarak inceledik. 14000 kontrastlı ÇKBT görüntüsü değerlendirildi. Sadece aort tutulumu olmayan izole renal arter diseksiyonları dahil edildi. Yaş, cinsiyet, semptomlar, tromboz veya renal parankimal iskemi-enfarkt varlığı kaydedildi. Ortalama diseksiyon uzunluğu ve orijinden uzaklık ölçüldü. Bulgular: 8 (% 0,054) hastada spontan izole renal arter diseksiyonu (5E, 3K, yaş aralığı 43-61) vardı. Orjinden ortalama uzaklık 3,7 cm ve ortalama diseke segment uzunluğu 3,8 cm idi. 3 hastada böbrekte parankimal enfarkt vardı. Sadece 1 hastaya dijital substraksiyon anjiyografisi yapıldı. Hastalara antikoagülan tedavi başlandı. Cerrahi veya girişimsel tedaviye gerek görülmedi. ÇKBT takibi yapılabilen hastalarda diseksiyonlar tamamen kayboldu. Sonuç: Spontan izole renal arter diseksiyonu çok nadir görülen bir durumdur. Etiyoloji iyi bilinmemektedir. İlk semptomlar genellikle nonspesifik olup şiddetli karın veya yan ağrısıdır. Tıbbi, cerrahi veya girişimsel yönetimler gibi çeşitli tedavi seçenekleri mevcuttur. Erken teşhis, komplikasyonları önlemek için önemlidir. Yeni başlayan böğür veya karın ağrısı olan hastalarda düşünülmelidir.

Anahtar Kelimeler:

Renal arter diseksiyonu, izole, spontan, bilgisayarlı tomografi, nadir

Detecting acute spontaneous isolated renal artery dissection with contrast enhanced multidetector computed tomography

Purpose: Spontaneous isolated renal artery dissection is a very rare but threatening condition that can be difficult to diagnose early due to nonspecific symptoms. The goal of this study is to evaluate the incidence and multidetector computed tomography (MDCT) findings of this rare and important condition. Materials and methods: We retrospectively examined the images of all patients who underwent contrast enhanced abdominal MDCT scans due to various abdominal complaints between July 2017- July 2020. 14000 contrast enhanced MDCT scans were evaluated. Only the isolated renal artery dissections without aortic involvement were included. Age, gender, symptoms, presence of thrombosis or renal parenchymal ischemia-infarct were noted. Average extension of dissection and distance from origin were measured. Results: 8(0,054%) patients had spontaneous isolated renal artery dissection (5M, 3F, age range 43-61 years). The mean distance from origin was 3.7 cm and the average extension was 3.8 cm. 3 patients had kidney infarct with a focal area of decreased perfusion. Only 1 patient underwent digital subtraction angiography. Patients were started on an anticoagulation therapy. No surgical or interventional therapy was deemed necessary. Dissections completely disappeared in patients who could undergo follow-up MDCT. Conclusion: Spontaneous isolated renal artery dissection is a very rare condition. The etiology is not well known. The initial symptoms are generally nonspecific such as severe upper abdomen or flank pain. There are several treatment options available such as medical, surgical or interventional managements. Early diagnose is important to prevent complications. It should be considered in patients with new-onset flank or abdominal pain.

Keywords:

Renal artery dissection, isolated, spontaneous, computed tomography,

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