Abdominal Aortic Pseudocoarctation Associated with Renal Artery Occlusion

Abstract

A 45 -year-old man was admitted to hospital due to uncontrolled hypertension. He had hypertension for 15 years and was on trandolapril+verapamil and cardura treatment. One year ago renal artery stenosis was detected by ultrasound but the patient declined further evaluation at that time. He had no symptomatic coronary artery disease or peripheral arterial disease. He denied chest pain, intermittent claudication and syncope. At admission blood pressure was 200/110 mm Hg and there was no difference at both arms. There was no pulse delay in the lower extremities. Pulse examination was normal. There were no murmurs at cardiac auscultation. No carotid bruit was heard. There was a severe abdominal bruit over the trajectory of the left renal artery. Serum creatinine was 1.1 mg/dl and potassium was 4.6 mEq/l. There was normal urinalysis. Renal Doppler ultrasound showed the following findings: right kidney 10444 mm, left kidney 11645 mm, cortical thickness was normal and echogenity was grade 1 increased. Contrast-enhanced abdominal CT angiography (figure There was severe tortuosity in the distal parts of the aorta along with an aortic pseudocoarctation. The origin of the left renal artery from the aorta was not sufficiently visualised. Nephrogram was delayed in the left kidney.