Spectral CT
Truth in beauty and beauty in layers...

Cases

Thank you, Dr. Page!

A young woman, with history of type 2 DM and hypertension, presents with severe back pain after a per-cutaneous native kidney biopsy. Recorded blood pressure is 212/120, much higher than her baseline of about 160/90. A CT scan is performed which shows the expected perinephric hematoma. But can we tie it all together?

Of course, with Spectral CT, we can. This is a classic case of Page kidney.

Conventional CT images show the large perinephric collection. The virtual non-contrast images show it is hyperdense, consistent with a hematoma. Note the left kidney has decreased iodine uptake.

Dr. Irvine Page, way back in 1939, described development of hypertension in dogs by constricting kidney in cellophane. Presumably, the kidney gets ischemic and activates the renin-angiotensin system. Spectral CT confirms the hematoma, and also shows us the ischemia in the affected kidney.

Dr. Page went on to be the first chair of research at the Cleveland Clinic, and was featured on the cover of TIME magazine in 1955. A true hot shot!

Conventional CT with large left perinephric collection (yellow arrows).

Conventional CT with large left perinephric collection (yellow arrows).

Virtual non-contrast: Collection is very dense, consistent with hematoma

Virtual non-contrast: Collection is very dense, consistent with hematoma

Decreased iodine uptake in left kidney confirms ischemia. Thank you, Dr. Page!

Decreased iodine uptake in left kidney confirms ischemia. Thank you, Dr. Page!

Dr. Page was really on the cover of TIME magazine (picture from TIME website, accessed on 10/28/2018)

Dr. Page was really on the cover of TIME magazine (picture from TIME website, accessed on 10/28/2018)

Gopal Punjabi