Wedge-shaped renal lesions

Fig. 5. The reason why we considered that wedge-shaped contrast enhancement reflected a vascular lesion. We infused microspheres in the rat heart, and performed glomerular supervital staining with Alcian blue. In this rat, renal infarction was detected. This was the basis of the hypothesis that wedge-shaped lesions are related to vasoconstriction (p. 4)...

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. 

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. 

Sakemi T, Ikeda Y, Matsuo Y, Kudo S, Nishihara G, BabaN (1996) Renal wedge-shaped lesions on computed tomography and ultrasonography in two patients who developed acute renal failure with severe loin pain after exercise. Nephron 73 679-681... 

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