Renal Infarction

Even More Pain

Step 1: View clinicals

A 65 year old man presents with pain in the left upper abdomen, which started abruptly around an hour ago. He has also experienced several episodes of vomiting since. His medical history is significant for type 2 diabetes, which was diagnosed 5 years ago, and is currently well controlled on metformin 1g/day. His surgical and family histories are unremarkable. He has smoked 20 pack years in total, but stopped doing so around 6 months ago. He only drinks socially. A complete blood count, renal profile, liver profile, and amylase and lipase levels are within normal limits, while a random capillary glucose is 127 mg/dL.


Step 2: Order all relevant investigations

ECG

The ECG shows an irregular baseline with absent P waves. No other abnormalities are present, and serial ECGs show no dynamic changes.

Ultrasound Abdomen

The ultrasound scan of the abdomen fails to reveal any abnormalities.

Contrast CT Abdomen

The CT scan shows a hypoenhancing wedge-shaped shadow at the upper pole of the left kidney, with a zone of peripheral diminished density without enhancement.

Diagnostic Laparoscopy

You realize that diagnostic laparoscopy is not indicated right now.


Step 3: Select appropriate management

Antibiotics
Anticoagulation
Angioplasty
Thrombectomy


Score: ★★☆