Case 46

Clinical Presentation

A 42-year-old man with uncontrolled hypertension. Examination was performed post captopril (images and curves shown in Figs. A and B). Baseline examination was normal symmetric (baseline curve shown in Fig. C; right is red, left green; baseline images not shown).

Imaging Findings

(A,B) Posterior images and renogram curves from a Tc99m-MAG3 captopril renal scan demonstrate normal uptake and excretion by the left kidney into an extrarenal pelvis (A, arrow), which progressively clears over time, arguing against obstruction. On the right, there is progressive radiotracer extraction but no demonstrable excretion (A, circle), with resultant flattening of the renogram curve (B, arrow). There is decreased relative right renal function (calculated to be 41% for the right, 59% for the left) as measured at peak uptake at 2.5 minutes (B, asterisks). (C) Renogram curve from the baseline examination before captopril demonstrates normal excretory curves bilaterally (arrow) and symmetric parenchymal function (asterisk).

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