Detection of segmental branch renal artery stenosis by Doppler US: a case report

Abstract

In stenosis of a segmental branch or among multiple renal arteries, Doppler sampling of intrarenal arteries in the upper, mid and lower poles demonstrates strikingly different waveform patterns that might otherwise be overlooked. We report a case of segmental branch renal artery stenosis in which a pulsus parvus et tardus waveform was observed in a segmental branch of a renal artery. In this case, systematic analysis of Doppler waveforms of intrarenal arteries at more than three different locations facilitated a rapid and confident diagnosis of segmental branch renal artery stenosis.

Fig. 1

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.

Fig. 2

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).