Spontaneous renal artery dissection

47 yo M presents with sudden onset LUQ pain.

Conventional CT shows focal cortical hypo-density in left kidney. Note complete absence of iodine uptake on spectral analysis, consistent with infarct.

Careful evaluation of left renal artery on 40 keV images shows a distinct flap consistent with dissection. No central source of clot was discovered, and patient was managed conservatively.

This is a pretty rare entity, not previously described with spectral CT.

Conventional image shows hypodensity in letf kidney

Complete lack of iodine confirms a renal infarct

Fusion image nicely demsntrates lack of iodine uptake

40 keV image clearly shows the renal artery flap consistent with dissection (yellow arrow). Low Kev reconstructions can be used as virtual CT angiograms.