case_images: PMC2718096_01
case_images: Spectral Doppler studies at intrarenal arteries of the left kidney.. A. Longitudinal sonogram of this kidney shows a normal appearance. Doppler sample volume was placed in a distal segmental artery or proximal interlobar artery in the mid pole. Doppler tracings show a very abrupt rise to peak systolic velocity. The RI value was 0.6.. B. Doppler tracings at an intrarenal artery in the lower pole demonstrate slowed systolic upsweep and dampened maximum systolic Doppler shift. Note decreased slope during early systolic upsweep. The waveform is less pulsatile than that seen in A. The RI value was 0.45.
case_images: kjr-2-57-g001.jpg
case_images: PMC2718096_01_kjr-2-57-g001.jpg
case_images: F1
case_images: Doppler US of intrarenal arterial branches in the upper and mid poles of the left kidney demonstrated normal waveforms (Fig. 1A), but in the lower pole, abnormally small and prolonged Doppler waveforms were noted, suggestive of upstream renal artery stenosis or occlusion (Fig. 1B).
case_images: Digital subtraction angiography in the same patient.. A. Aortogram shows mild luminal irregularity in the abdominal aorta. The main renal arteries are intact and single on each side. A severely narrowed segment (black arrow) is noted in a segmental branch of the left renal artery.. B. Selective left renal arteriogram shows a stenotic lesion (black arrow) in the posterior division of the left renal artery (more than 90% stenosis). A further stenotic lesion (white arrow) is seen in a segmental branch of the anterior division of the left renal artery (more than 50% stenosis).
case_images: kjr-2-57-g002.jpg
case_images: PMC2718096_01_kjr-2-57-g002.jpg
case_images: F2
case_images: Both main renal arteries were intact, and on each side there was one only; on the left, severe luminal narrowing was noted in a lower segmental branch (Fig. 2A). Selective left renal angiography depicted a severe (>90%) stenotic lesion in a segmental branch supplying the lower pole of the left kidney, and a further such lesion (more than 50% stenosis) in a segmental branch of the anterior division of the left renal artery (Fig. 2B).