Korean Circ J.  2010 Jan;40(1):42-45. 10.4070/kcj.2010.40.1.42.

Flash Pulmonary Edema in a Patient With Unilateral Renal Artery Stenosis and Bilateral Functioning Kidneys

• Noh HJ
• Jo HC
• Yang JH
• Kim SM
• Lee HJ
• Choi JH
• Choi SH
• Song BG
• Choe YH
• Choi SH
• Kim DK
• Cho DK

• KMID: 1776305
• DOI: http://doi.org/10.4070/kcj.2010.40.1.42

Abstract

Flash pulmonary edema typically exhibits sudden onset and resolves rapidly. It generally is associated with bilateral renal artery stenosis or unilateral stenosis in conjunction with a single functional kidney. We describe a patient who presented with flash pulmonary edema treated by percutaneous therapy with stent implantation. Our case is unique in that the flash pulmonary edema occurred in the setting of unilateral renal artery stenosis with bilateral functioning kidneys.

Keyword

Pulmonary edema; Renal artery obstruction; Stents

MeSH Terms

Constriction, Pathologic
Humans
Kidney
Pulmonary Edema
Renal Artery
Renal Artery Obstruction
Stents

Figure

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  Fig. 1 Chest radiograph demonstrates bilateral interstitial shadowing compatible with pulmonary edema (A) that subsided soon after admission (B).

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  Fig. 2 Axial view (A) and volume rendering image (B) of CT angiography shows unilateral severe stenosis of the right renal artery beginning at its ostium.

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  Fig. 3 The selective renal angiography reveals a 95% segmental ostial stenosis in the right renal artery (A) and demonstrates successful stent implantation (B). The follow-up CT angiography reveals no stenosis two months after the stent placement (C).

Reference

1. Pun E, Dowling RJ, Mitchell PJ. Acute presentations of renal artery stenosis in three patients with a solitary functioning kidney. Australas Radiol. 2004. 48:523–527.

2. Sharifkazemi MB, Zamirian M, Astani A. Flash pulmonary edema heralding renal artery spasm. Cardiology. 2008. 109:66–67.

3. Perkovic V, Thomson KR, Mitchell PJ, et al. Treatment of renovascular disease with percutaneous stent insertion: long-term outcomes. Australas Radiol. 2001. 45:438–443.

4. Garovic VD, Textor SC. Renovascular hypertension and ischemic nephropathy. Circulation. 2005. 112:1362–1374.

5. Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001. 344:17–22.

6. Choi DH, Hong BK, Shim WH, Jang YS, Cho SY. Stenting in renal artery stenosis. Korean Circ J. 1997. 27:703–711.

7. Olin JW. Renal artery disease: diagnosis and management. Mt Sinai J Med. 2004. 71:73–85.

8. Oh GY, Lee GH, Jeon DS, et al. A case of renal hypertension with unilateral renal artery stenosis and contralateral hypoplastic kidney. Korean Circ J. 1998. 28:448–452.

9. White CJ. Catheter-based therapy for atherosclerotic renal artery stenosis. Prog Cardiovasc Dis. 2007. 50:136–150.

10. Choo DC, Fisher DZ. Renal artery stenosis: when to intervene? Cardiol Rev. 2003. 11:257–261.

11. Mansoor S, Shah A, Scoble JE. Flash pulmonary oedema: a diagnosis for both the cardiologist and the nephrologist? Nephrol Dial Transplant. 2001. 16:1311–1313.

12. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006. 47:1239–1312.