DIAGNOSTIC DILEMMA: NEPHROLOGY

Magnetic resonance angiography revealed poor perfusion to the caudal ventral half of the left kidney and wedge-like perfusion abnormalities in the upper dorsal right kidney, consistent with bilateral renal infarcts. In addition, an enlarged caliber and abnormal contour were visible in the mid-to-distal portion of the left renal artery, and dissection was apparent in the distal region (Figures 1A-D) The inferior pole of the left kidney was not enhanced by gadolinium contrast, indicating that dissection of the artery supplying it had caused infarction (Figures 2A-B). Two right renal arteries were centrally patent, and the vessel in the upper-pole had caliber changes and contour irregularities similar to those seen in the left renal artery (Figures 3A-B).