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Case 16

Aortic graft thrombosis, renal infarction

A middle aged man with sudden left flank pain

This 50 year old man presented to the Emergency Department with a sudden onset of pain in the left flank. The pain had persisted for several hours. He gave a past history of hypertension, and of aortic surgery a few years previously for intermittent claudication.

He was referred for CT scanning due to the suspicion of a ruptured aortic aneurysm. Two sample images are presented from a contrast enhanced study.

Findings

The two images were obtained through the renal area, the first several slices above the second.

Both show focal areas of hypoperfusion in the left kidney. Furthermore on the lower image there is no contrast enhancement of the aortic lumen.

Diagnosis

Thrombosis of the aorta and aortic graft
Renal infarction

Discussion

The more distal images demonstrated the nature of his previous surgery. He had undergone an aortobifemoral graft procedure for aortic thrombosis. There was no aortic aneurysm and no leak from the graft, which was in fact thrombosed. Despite this the patient had no symptoms of ischaemia in the legs, and the graft may have been occluded for some time, with a good collateral circulation.

Any new emboli, such as from the heart or an atheromatous plaque, would then tend to enter the renal arteries rather than the distal circulation, resulting in renal infarction and flank or loin pain.

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