Contrast CT of the abdomen is the recommended investigation of acute anuria, flank pain, and severe acute kidney injury.1'2 Figure 4 demonstrates a parenchymal phase contrast-enhanced CT image of a healthy individual for comparison. In the healthy individual, there is strong uniform enhancement of the renal cortex and less progressive enhancement of the medulla (arrow). In Fig 1, the parenchymal phase contrast-enhanced CT image of the renal medulla (black arrow) shows greater enhancement than the cortex, which is consistent with reduced or absent cortical blood flow. There also is faint enhancement of the subcapsular cortical rim (white arrow). The contrast-enhanced CT angiogram demonstrates enhancement of the main renal arteries to the level of the renal sinuses bilaterally (white arrows; Fig 2). These features suggest bilateral renal cortical necrosis, with the nonenhancing. cortex forming a hypodense zone between the medulla and subcapsular cortical rim (Fig I). Later imaging studies (weeks to months) may show a reduction in kidney size and a characteristic rim of renal cortical calcification.
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