Posttraumatic giant renal pseudoaneurysm

Giant renal artery pseudoaneurysm 18 months after blunt trauma

Renal artery pseudoaneurysms are uncommon vascular lesions that require a high degree of suspicion because they are usually difficult to diagnose. Posttraumatic renal artery pseudoaneurysms should be treated because spontaneous resolution is extremely unusual, and the risk of aneurysm rupture is high. We describe the case of a patient who presented with a pulsatile mass in the right upper quadrant and recurrent abdominal pain 18 months after blunt trauma. Arteriography and multislice computed tomography angiography revealed a pseudoaneurysm measuring 22 cm in the right renal artery. The patient was successfully treated with conventional open surgery.

Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature

CONTEXT

Renal artery pseudoaneurysm is a rare complication after renal injury but should be suspected whenever there is recurrent hematuria after renal trauma.

CASE REPORTS

We present three cases of pseudoaneurysm after blunt renal trauma and a review of the literature. All patients underwent renal angiography. Two cases were diagnosed during the initial hospital stay due to hematuria, or in the follow-up period during recovery. One patient was hemodynamically unstable. Two patients successfully underwent coil embolization in a single session. In the other case, selective embolization was attempted, but was unsuccessful because artery catheterization was impossible. Procedural and medical success and complications were retrospectively assessed from the patients' records. The clinical presentation, treatment options and clinical decisions are discussed.

CONCLUSIONS

Renal artery pseudoaneurysm may develop acutely or even years after the initial injury. Signs and symptoms may have a wide spectrum of presentation. Selective angiographic embolization is an effective treatment that reduces the extent of parenchymal infarction.

Acute conditions affecting the perinephric space: imaging anatomy, pathways of disease spread, and differential diagnosis

The perinephric space is an important, central compartment of the retroperitoneum which may host various acute conditions. Imaging evaluation of the perinephric space requires an understanding of its anatomy and the pathways of disease spread to and from other retroperitoneal compartments. Numerous acute conditions can affect the perinephric space and may occur in isolation, extend from nearby retroperitoneal structures, or be part of a systemic condition. Familiarity with the key imaging findings of acute conditions affecting the perinephric space is imperative to facilitate diagnosis and guide treatment. The purpose of this article is to review and illustrate the relevant anatomy, pathways of disease spread, and acute pathology encountered during cross-sectional imaging evaluation of the perinephric space.

Pseudoaneurysm and renal arteriovenous fistula after nephrectomy: two cases treated by transcatheter coil embolization

Pseudoaneurysms and arteriovenous fistulas of renal arteries are rare clinical lesions. Invasive renal procedures may lead to pseudoaneurysm or arteriovenous fistulas (AVFs). We report two pseudoaneurysms and arteriovenous fistula cases that were treated by transcatheter embolization with metallic coils. The first case is left main renal artery pseudoaneurysm after nephrectomy in a patient with a solid renal tumor. The second case is right main renal artery AVF with giant pseudoaneurysm after both gunshot injury and nephrectomy. On the basis of color Doppler sonography and computed tomography (CT) findings, cases were diagnosed as pseudoaneurysm after nefrectomy. Contrast-enhanced CT scans showed a hyperdense area within the hematoma consistent with pseudoaneurysm. Endovascular treatment with coil embolization succeeds to total occlusion in renal artery pseudoaneurysm. Delayed hemorrhage related to postnephrectomy may be life-threatening conditions because of diagnostic difficulties. AVF and pseudoaneurysm can be treated safely and successfully by transcatheter arterial embolization.