Abnormal Imaging Findings of the Kidneys in a Patient with Shock.

Abstract

A 19-year-old woman arrived at the hospital after a gunshot wound to the chest. She was minimally responsive and hemodynamically unstable, with a systolic BP of 60 mm Hg and heart rate at 150 beats per minute. She underwent exploratory thoracotomy with pulmonary artery repair and wedge resection of the left lung. She received massive blood transfusion and fluid resuscitation and, subsequently, developed abdominal compartment syndrome requiring decompressive laparotomy. She was maintained on vasopressor support in the intensive care unit. On presentation, serum creatinine was 0.7 mg/dl, but kidney function quickly deteriorated, leading to anuria and a rise in serum creatinine to 2.9 mg/dl on day 5. On day 10, due to persistent hypoxia, increasing vasopressor requirement, and leukocytosis, a contrast-enhanced computed tomography (CT) scan was performed. The scan showed a grossly distorted appearance of the kidneys, with hypodensity of the renal cortices with patchy …