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Journal of Clinical Images and Medical Case Reports

ISSN 2766-7820
Clinical Image - Open Access, Volume 3

Middle - aortic syndrome with a thrombus in the renal artery

H Foudad1*; I Bouague Li1; K Selmani2; A Trichine1

1 Department of Cardiology, Military Hospital of Constantine, Algeria

2 Department of Radiology, Military Hospital of Constantine, Algeria.

*Corresponding Author: H Foudad
Department of Cardiology, Military City of Military Hospital, Military Hospital of Constantine, Algeria.
Email: [email protected]

Received : Nov 24, 2021

Accepted : Jan 13, 2022

Published : Jan 20, 2022

Archived : www.jcimcr.org

Copyright : © Foudad H (2022).

Citation: Foudad H, Bouague I, Selmani K, Trichine A. Middle - aortic syndrome with a thrombus in the renal artery. J Clin Images Med Case Rep. 2022; 3(1): 1593.

Description

A 22-year-old man with no previous medical history was admitted in our hospital for management of severe hypertension.

It’s a patient followed disorderly for high blood pressure for six months under ARB (Angiotensin II Receptor Blockers) and Calcium Antagonist with a recent elevation of his blood pressure in spite of association of a B-Adrenergic Blocker and a thiazide diuretic.

On physical examination his blood pressure measured 220/120 mmHg in both arms, with a regular pulse of 59 beats per minute. Auscultation of the abdomen revealed a murmur in the upper abdomen. Peripheral pulsations were all palpable and there was no history of abdominal pain or claudication. Serum creatinine was 67 umol/ l and Modification of Diet in Renal Disease-Glomerular Filtration Rate (MDRD-GFR) was >90 ml/ min/1.73 m2.

Doppler ultrasound examination demonstrated tortuosity and narrowing of the abdominal aorta with signs of the renal artery stenosis; following which he underwent Computed Tomography (CT) angiography.

Tomography (CT) angiography revealed a long segment stenosis of abdominal aorta with a thrombus in the right kidney multiple collateral vessels (Figures 1 to 4).

After discussions, a chirurgical treatment was decided; an aorto-aortic bypass from the descending thoracic aorta to the aortic bifurcation using a Dacron graft and aspiration of the thrombus in the renal artery.

The post-operative period was uneventful, his blood pressure dropped to 145/85 mmhg

Figure 1: CT Scan showing epidural hematoma with associated diffuse subarachnoid hemorrhage.

Figure 2: Angiography showing a long segment stenosis of abdominalaorta with multiple collateral vessels supplying the right kidney

Figure 3: See the critical obstacle in the abdominal aorta including the right renal artery

Figure 4: Showing the thrombus in the right renal artery (arrow).

References

  1. Rossi MA. Infrarenal aortic coarctation and diffuse hypoplasia of the aortoiliacfemoral system. Acta Cardiol. 1997; 52: 373–9.
  2. Cohen JR, Birnbaum E. Coarctation of the abdominal aorta. J VascSurg. 1998; 8: 160–164.
  3. Sen PK, Kinare SG, Engineer SD, et al. The middle aortic syndrome. Br Heart J. 1963; 25: 610–618.
  4. Connolly JE, Wilson SE, Lawrence PL, Fujitani RM. Middle aortic syndrome: Distal thoracic and abdominal coarctation; a disorder with multiple etiologies. J Am CollSurg. 2002; 194: 774–781.