RENAL VASCULAR IMPRESSIONS

INCIDENCE AND CLINICAL SIGNIFICANCE

¹ Instructor in Radiology, Harvard Medical School, and Assistant Radiologist, Massachusetts General Hospital, Boston, Massachusetts
² Surgery Branch, National Cancer Institute, National Institute of Health, Bethesda, Maryland

Arterial impressions were seen in 18 per cent of 115 unselected angiograms and were 3 times more frequent on the right side. Arterial impressions were more common in the superior infundibulum and renal pelvis than in other portions of the collecting system. In only 1 case of the 115 unselected cases did there appear to be any significant caliectasis in association with an arterial impression.

Renal vascular impressions usually are insignificant but occasionally may be associated with symptomatic and clinically significant intrarenal obstruction. Two cases with nephralgia and proven superior infundibular obstruction due to crossing vessels are reported. A persistent vascular impression in the superior infundibulum is significant if there is also localized caliectasis and retention of contrast material on delayed drainage roentgenograms of retrograde pyelography in a symptomatic or infected patient with no other cause for infection. Cineroentgenographic evidence of interference with peristalsis should also be seen at the site of obstruction. If the area of narrowing is in apposition to a renal vessel on both anteroposterior and oblique angiograms, the vessel is assumed to be the cause of the obstruction, but surgical confirmation is necessary to exclude obstruction due to other causes.

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