0:00

Okay, so here we have another contrast

0:03

enhanced CT scan of the abdomen and pelvis.

0:05

And again, we're seeing some, a little bit

0:07

of consolidation here in the left lower lobe,

0:09

some tiny imperfections in this patient.

0:11

Um, we also see a bit of periportal halos

0:14

as we saw in other cases consistent with,

0:16

uh, periportal edema in this patient.

0:19

Now as we come down, we're going to

0:20

see that the liver enhances pretty

0:22

homogeneously besides that periportal edema.

0:26

But on the other side where we always look at the

0:28

spleen, you can see that the spleen is heterogeneous

0:30

here with multiple peripheral, one would say wedge

0:35

type low attenuation regions within the spleen.

0:38

That is a classic appearance of splenic infarcts.

0:42

Additionally, as we come to the

0:44

retroperitoneal location, you can see multiple

0:47

low attenuation regions within the kidneys

0:50

bilaterally in that wedge-shaped appearance.

0:52

Again, that is a beautiful

0:55

appearance of renal infarcts.

0:57

Unlike the pyelonephritis that

0:59

was kind of gray in attenuation,

1:01

chis is lack of blood flow

1:03

causing ischemic wedge type infarcts, and as a result

1:06

of it being infarcted tissue rather than normal tissue,

1:10

these are actually very low in attenuation because

1:12

there's absolutely no blood flow to these locations.

1:14

Um, this is a classic appearance

1:16

of bilateral renal infarcts.

1:19

Again, we'll go on coronal, just to give you

1:21

a better look at that wedge-shaped appearance.

1:23

I feel like that looks like an apple pie to me.

1:25

I could have it with

1:26

some whipped cream.

1:27

And on the other side we have

1:29

multiple pie pieces as well.

1:30

So this is a patient who has bilateral

1:34

renal infarcts and splenic infarcts as well.

1:37

So mostly this,

1:38

this is going to be embolic in nature.

1:40

Uh, we would look carefully at the heart in a

1:42

patient like this or suggest an echocardiogram

1:45

as a source for their showering of emboli.

1:49

You also have to hope that they aren't

1:50

embolizing to anything more vital

1:52

in their head, such as their brain.

1:55

So this is an emergent situation in this

1:57

patient, but that's also a nice imaging

2:00

example of embolic disease within the abdomen and pelvis.

Case: Renal Infarcts

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