54 year-old female with LUQ pain

 

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Doctor's Information

Name : Hamidreza
Family :Haghighatkhah
Affiliation : Radiology department,ShohadaTajrish Hospital,SBMU
Academic Degree: Associate professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Mansour Shakeri

 

Case Section

Cardiovascular

 

Patient's Information

Gender : Female
Age : 54

 

Clinical Summary

54 year-old female with LUQ pain

 

 

Imaging Findings

Multiple wedge-shaped areas of non-enhancement are seen in spleen and left kidney. Associated left renal atrophy is also detected.A small clot in left ventricle is appreciated as well. The mentioned-findings are in favor of splenic and renal infarct resulting from distant embolism of cardiac origin.

 

Differential Diagnosis

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Final Diagnosis

splenic and left renal infarction

 

Discussion (Related Text)

Splenic infarct occurs commonly and has various causes. The splenic arterial branches are end arteries with no intercommunication. Causes of splenic infarct include embolic disease (e.g., mitral valve disease, endocarditis, atheromatous plaques), arteritis, splenic artery aneurysm or occlusion (pancreatic disease), sickle cell disease (thrombosis), and mass lesions. Most cases are asymptomatic, although some patients experience the acute onset of left upper quadrant pain. Infarcts are typically focal but can be diffuse. Infarcts in younger patients are more often due to thrombosis from a hematologic disorder; infarcts in older patients tend to be embolic. On cr and MR!, infarcts are usually wedge shaped but may be irregular in contour. Although the infarct has no enhancement, there may be peripheral enhancement of the capsule. Infarcts can also be multiple. As described previously, differentiating between infarct and abscess or tumor can be difficult. The lack of mass effect and perisplenic changes suggests infarct. Over time, infarcts shrink. Any increase in size is suspicious for superimposed infection. On MRl the signal of the infarct can vary, depending on its composItIon and age. Hemorrhagic infarcts may be of high signal intensity on Tl- and T2- weighted images. Renal infarction may be due to renal artery thrombosis or embolism, vasculitis as in polyarteritis nodosa, trauma, sickle cell disease, or aortic dissection. The most common cause is thromboembolism from cardiovascular disease. The main cr differential diagnosis of acute renal infarction is acute pyelonephritis because both conditions often demonstrate wedge-shaped, low-attenuation renal lesions on cr and often manifest as acute onset of flank pain and fever. A cortical rim sign should strongly suggest the diagnosis of renal infarction because it is usually not seen in acute pyelonephritis345 Small renal infarcts may also be confused with focal lymphomatous lesions or metastases on CT.

 

References

Haaga J: CT and MR imaging of the whole body, 5th ed. Philadelphia: Mosby, 2009, pp1799-1800.

 

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