J Korean Soc Emerg Med.  2012 Dec;23(6):907-911.

Clinical Progression of Segmental Arterial Mediolysis; Renal Infarction and Intra-abdominal Hemorrhage

• Choi JH
• Cho YS
• Kim JW
• Lee JW
• Moon HJ

Abstract

This article reports a patient with both a renal infarction and acute intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis. The patient was a 37-year-old male who presented with acute right flank pain. Abdominal and pelvic computerized tomography (CT) showed a right renal infarction. After three days, the right flank pain had diminished but left flank pain began. Visceral angiography revealed a wedge shape perfusion defect at the mid pole of the left kidney, suggesting a left renal infarction but there were no definite perfusion defects at the right kidney. After ten days, the patient complained of abdominal pain and 2 episodes of syncope. Abdominal CT revealed active bleeding from the splenic artery and a large amount of hemoperitoneum. After emergency embolization, the patient's were stabilized. After 28 days, his condition was improved and discharged without complications. The angiographic and laboratory findings were consistent with a diagnosis of segmental arterial mediolysis involving the renal and splenic artery. This is the first case report of clinical progression related to segmental arterial mediolysis requiring emergent coil embolization.

Keyword

Renal artery obstruction; Hemoperitoneum; Angiography

MeSH Terms

Abdominal Pain
Angiography
Emergencies
Flank Pain
Hemoperitoneum
Hemorrhage
Humans
Infarction
Kidney
Male
Perfusion
Renal Artery Obstruction
Splenic Artery
Syncope
Vascular Diseases