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Renal infarction appearing as an echogenic mass.

A 59-year-old woman with several years of hypertension was admitted to Stanford University Hospital for evaluation of increasingly severe bilateral leg claudication. She denied previous urinary tract infections, renal calculi, flank pain, and hematuria. Admission physical examination revealed a moderately obese woman with mild hypertension and diminished lower extremity pulses bilaterally. An abdominal aortogram and lower extremity run-oft arteriogram were obtained. No selective renal artery injections were made. Severe atherosclerotic narrowing of the infrarenal aorta and iliac arteries was present. Each kidney was supplied by two renal arteries. There was proximal occlusion of the inferior left renal artery. The lower pole of the left kidney was avascular (fig. i A) and gave the appearance of an avascular lower pole renal mass. Renal sonography demonstrated a smooth, homogeneously echogenic wedge-shaped lower pole left renal mass, without posterior shadowing (fig. 1 B). No focal contour defect was noted. The rest of the left kidney was normal. An aorta/bilateral femoral artery bypass graft was placed. At the time of surgery, the lower pole of the left kidney was closely examined and was noted to be the site of an old, completed renal infarction, with only minimal tissue atrophy. No pathologic specimen was obtained.