Bilateral acute cortical necrosis is a rare form of acute renal failure cha
racterized by necrosis of the renal cortex and sparing of the medulla. Litt
le information on the imaging presentation of bilateral acute renal cortica
l necrosis is available. The enhanced CT appearance is pathognomonic and di
agnostic. The unilateral presentation of acute cortical necrosis is extreme
ly rare, and no imaging methods have been described. The authors chose to a
pply scintigraphic evaluation to this unique condition complementary to CT
to confirm the diagnosis. Mercaptoacetylglycine (T3) was selected to assess
tubular damage, in contrast to the pure glomerular agent DTPA. Evidence of
some tubular function and clear delineation of the shrunken kidney was fou
nd. Conversely, in the DTPA study the kidney was not visualized. A DMSA sca
n was performed for assessment of viability of the renal cortex and showed
a photopenic halo around the small area of the viable cortex of the upper p
ole. The halo sign represents a cortical loss. The visualization of the upp
er pole as evidence of cortical viability as a consequence of collateral bl
ood flow from capsular vessels was seen on angiography. Radiographic and sc
intigraphic correlation of this rare condition may be an effective means to
confirm the diagnosis and to establish the extent of involvement. However,
contrast CT remains the preferred method in the diagnosis of acute cortica
l necrosis.