Computed tomography three-dimensional reconstruction in the diagnosis of traumatic renal artery thrombosis

A 38-year-old woman was a restrained passenger in a high-speed motor vehicl e accident. On initial evaluation, the patient was found to be hemodynamica lly stable and complaining of left-sided abdominal and flank pain. Her hema tocrit was 38% (normal 36% to 46%) and serum creatinine 0.9 mg/dL (normal 0 .7 to 1.5), and the urinalysis was normal. Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was performed (Fig. 1 ). CT demonstrated no perfusion to the left kidney, and the right kidney de monstrated prompt enhancement and excretion of contrast. Her only other inj uries included a nasal fracture and left olecranon fracture. The patient wa s 5 hours postinjury and was treated nonoperatively because of the normally functioning right kidney. Her abdominal and flank pain resolved promptly a nd she was discharged 5 days after the injury with normal blood pressure an d serum creatinine. A follow-up CT was performed 2 months later with three- dimensional. reconstruction to image the renal vasculature (Fig. 2). Note t he abrupt cutoff of the left main renal artery approximately 1 cm distal to its origin. At her 3-month follow-up visit, she was doing well with normal blood pressure.