Patchy lesions

This patient, who had autosomal dominant polycystic kidney disease (ADPKD), almost drowned and then developed ALPE. On July 20, 1990, he nearly drowned in the sea at 1500 hours, and was brought to our hospital by ambulance for dyspnea and severe loin pain at 1620 hours. On admission, metabolic acidosis was observed. His CRP, serum creatinine, CPK, amylase, and urinary protein levels were 1+, 1.5mg/dl, 116 U/l, 592IU/1 (derived from the salivary gland), and 2+, respectively. His body temperature was 37.7°C, and his blood pressure was 110/60 mmHg. His pulse and respiratory rate were 120/min and 22/min, respectively. Delayed CT 6h after the administration of contrast medium showed wedge-shaped contrast enhancement in the noncystic renal parenchyma (Fig. 34). On July 24, a bone scan with MDP revealed patchy lesions (Fig. 35). His serum creatinine level was 1.3 mg/dl, which had decreased to 1.0 mg/dl on July 27. The patient was then discharged. 

Fig. 35. Bone scan image with MDP in the same patient as in Fig. 34. A patchy lesion was observed. However, it was unclear whether this finding suggested ALPE or ADPKD...

This patient, who had ADPKD, developed ALPE after a sprint. On October 1,1995, he participated in two 100-m races at an athletics meeting in the morning. After a few hours, severe loin pain occurred, and he attended our department the following morning. There were no other abnormal findings, and his blood pressure, pulse, and serum creatinine values were 120/66 mmHg, 64/min, and 1.6mg/dl (serum creatinine level before onset 0.9mg/dl), respectively. On October 2, delayed CT 4 and 24 h after the administration of contrast medium showed patchy lesions (Fig. 37). On October 14, his serum creatinine level returned to 1.1 mg/dl, and CT 4h after the administration of contrast medium showed no contrast enhancement. 

On June 13,1998, this patient participated in 100-m, 400-m, and 1500-m time-trial races at 1400 hours. Left loin pain occurred at 1600 hours. He considered that he had caught a cold, and took a commercially available drug for colds and an analgesic agent. Initially, pain was marked in the sitting position, and became less marked in the supine position. However, it gradually became worse even in the supine position, and he attended the Emergency Outpatient Unit of our hospital at 0500 hours on June 14. His serum creatinine, total bilirubin, and CPK levels were increased to 2.1 mg/dl, 2.8 mg/dl (the reason for an increase in total bilirubin was unclear), and 329 U/L, respectively, and the patient was referred to our department. On June 14, CT 24, 48, and 96 h after the administration of contrast medium showed patchy lesions (Fig. 38)... 

This patient required hemodialysis for ALPE. Delayed CT and a bone scan with MDP in the recovery phase showed patchy lesions (these imaging procedures were performed in conjunction with another patient with myoglobin uric acute renal failure due to a malignant syndrome). On July 19, 1999, the patient fell into the water while fishing in a mountain stream, and was carried about 100 m in a few minutes while struggling all the time. As a precaution, he was admitted to a local clinic overnight. There were no abnormal laboratory data. However, at 0300 hours on July 21, he attended the Emergency Outpatient Unit of our hospital with severe bilateral loin... 

In this case, ALPE was complicated by nocturnal hemoglobinuria. At the age of 20 years, the patient developed nocturnal hemoglobinuria. He had been treated in the Department of Hematology and Immunology in our hospital. On June 18, 2000, he participated in a practice baseball game from 0900 hours until 1500. At 1700 hours, right abdominal and loin pain occurred. On June 19, his serum creatinine level was 3.4mg/dl (before onset, 0.7mg/dl). On June 22, CT 24h after the administration of contrast medium showed patchy lesions (Fig. 43). On June 26, his serum creatinine level had returned to 1.2mg/dl. 

MRI and a bone scan with MDP showed wedge-shaped contrast enhancement in some patients, although these procedures were less sensitive than CT. Patchy lesions could be visualized by a bone scan with MDP in Patients 5 (Fig. 18), 12 (Fig. 33), 13 (Fig. 35), and 16 (Fig. 40). This visualization was achieved by MRI in Patients 6 [35] (Fig. 26), 16 (Fig. 22 and Fig. 39), and 21 (Fig. 45). In the future, ultrasonography with Levovist will facilitate the visualization of lesions. 

In addition to ALPE, mild acute renal failure, including dehydration, acute pyelonephritis, and renal pelvic tumors, is visualized as wedge-shaped contrast enhancement [15]. However, acute pyelonephritis and renal pelvic tumors are visualized as unilateral lesions, whereas ALPE is visualized as a bilateral lesion therefore, differentiation is possible. For a definitive diagnosis, the presence of patchy contrast enhancement must be demonstrated when the serum creatinine level is in the range from 1.2 to 3.5 mg/dl. However, as described above, a definitive diagnosis is not always necessary in clinical practice. 

White matter lesions have been already quite extensively studied with CT and the patchy or diffuse abnormalities in the deep white matter, which... 

Bogousslavsky J, Van Melle G, Regli F (1988) The Lausanne Stroke Registry analysis of 1,000 consecutive patients with first stroke. Stroke 19 1083-1092 Brant-Zawadzki M, Fein G, Van Dyke C, Kiernan R, Davenport L, de Groot J (1985) MR imaging of the aging brain patchy white-matter lesions and dementia. Am J Neurora-diol 6 675-682... 

Usually not a disease of adults, this sporadic infection sometimes causes epidemics in schools. Its clinical appearance varies from mildly scaling lesions over alopecia (patchy hair loss) to highly inflamed, suppurative (kerion) variants, the latter usually caused by zoophilic species as the leading pathogen in... 

The lesions tended to be more severe and have a greater duration at higher doses. Histologically, the cornea appeared with patchy denudation of the epithelium and infiltration of neutrophils to the site of injury (Ballantyne et al, 1974). In general, more severe eye exposures have resulted from CN compared to CS agent. 

Lesions on sun-exposed skin, particularly the backs of the hands, forearm, and face, are present in all patients. These lesions are identical to those seen in the other bullous porphyrias (Table 32-4). Increased mechanical fragility of the skin, with trivial trauma leading to erosions, is present in virtually aU patients. Subepidermal bullae, hypertrichosis of the face, and patchy pigmentation are also common. Erosions and bullae heal slowly to leave atrophic scars, milia, and depigmented areas. Patchy or diffuse sclerodermatous changes are less common and, unlike the other skin lesions, may affect areas of the trunk that are not exposed to sun. 

Incontinentia pigment is an X-linked disorder that is lethal in utero for affected males. The findings vary in females and include pigmented skin lesions, dental abnormalities, patchy areas of alopecia, and mental retardation. Approximately 45% of cases are the result of new mutations. Which of the following descriptions of incontinentia pigmenti is most accurate ... 

Exposure to 480 mg for 60 min caused mortalities in rats (10% males, 5% females) and hamsters (males 34%, females 25%). Lungs of rats that died had congestion of alveolar capillaries and intrapulmonary veins, intra-alveolar hemorrhages, and patchy pulmonary edema. A few rats showed centrilobular or midzonal hepatic necrosis, and kidneys had extensive tubular necrosis, mainly medullary. Hamsters that died within 48 h had pulmonary congestion, intra-alveolar hemorrhages, and pulmonary edema. Kidneys showed corti-comedullary necrosis. Hamsters dying after 48 h showed minimal pulmonary lesions, but renal tubular necrosis was present. 

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