1
|
Lee S, Jung S, Kim HJ, Jang HN, Park DJ, Bae E, Lee TW, Chang SH. Spontaneous rupture of a renal artery pseudoaneurysm in a hemodialysis patient: A case report. Medicine (Baltimore) 2021; 100:e25970. [PMID: 34011081 PMCID: PMC8136987 DOI: 10.1097/md.0000000000025970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Renal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported. PATIENT CONCERNS A 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior. DIAGNOSIS Contrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms. INTERVENTIONS On renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed. OUTCOMES Post-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization. LESSONS When maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.
Collapse
Affiliation(s)
- Seunghye Lee
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital
| | - Sehyun Jung
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital
| | - Hyun-Jung Kim
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital
- Institute of Health Sciences, Gyeongsang National University, Jinju
| | - Ha Nee Jang
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital
- Institute of Health Sciences, Gyeongsang National University, Jinju
| | - Dong Jun Park
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Institute of Health Sciences, Gyeongsang National University, Jinju
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Eunjin Bae
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Institute of Health Sciences, Gyeongsang National University, Jinju
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Won Lee
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Institute of Health Sciences, Gyeongsang National University, Jinju
- Department of Internal Medicine-Nephrology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Se-Ho Chang
- Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University
- Department of Internal Medicine-Nephrology, Gyeongsang National University Hospital
- Institute of Health Sciences, Gyeongsang National University, Jinju
| |
Collapse
|
2
|
|
3
|
Sforza S, Persano G, Cini C, Sforzi I, Grosso AA, Bronzini F, Bussolin L, Acquafresca M, Masieri L. Renal pseudoaneurysm after blunt trauma in a 10-year-old girl: A case report. Urologia 2020; 88:157-159. [PMID: 31969047 DOI: 10.1177/0391560319896155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Renal trauma is a relevant cause of morbidity in children older than 1 year. Most patients are currently managed conservatively, even in case of high-grade traumas; nevertheless, harmful complications may occur even in hemodynamically stable patients. We present a case of grade IV blunt renal trauma complicated by post-traumatic pseudoaneurysm. CASE DESCRIPTION A 10-year-old girl was referred to our institution for grade IV trauma of the right kidney. During observation she had persistent hematuria that caused anemia. A second contrast-enhanced computed tomography scan revealed a posttraumatic pseudoaneurysm that was successfully treated by angiographic embolization. CONCLUSIONS Although extremely rare after blunt renal trauma, post-traumatic renal pseudoaneurysm may cause severe blood loss and anemia, and angioembolization is therefore indicated. This condition should be suspected and move physicians to investigate further.
Collapse
Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Pediatric Surgery, Pediatric Urology Unit, Meyer Children's Hospital, Florence, Italy
| | - Giorgio Persano
- Department of Pediatric Surgery, IRCCS Gaslini, Genoa, Italy
| | - Chiara Cini
- Department of Pediatric Surgery, Pediatric Urology Unit, Meyer Children's Hospital, Florence, Italy
| | - Idanna Sforzi
- Meyer Children Hospital, Trauma Center, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | | | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Pediatric Surgery, Pediatric Urology Unit, Meyer Children's Hospital, Florence, Italy
| |
Collapse
|
4
|
Letter to the Editor: Organ injury scaling 2018 update: Spleen, liver, and kidney. J Trauma Acute Care Surg 2019; 87:998-999. [DOI: 10.1097/ta.0000000000002413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Adeyemi J, Johnson J, Rits Y, Akingba AG, Rubin J. Ex Vivo Reconstruction and Autotransplantation for Hilar Renal Artery Aneurysms in Patients with Congenital Anomalies. Ann Vasc Surg 2017; 47:280.e5-280.e8. [PMID: 28893708 DOI: 10.1016/j.avsg.2017.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
Renal artery aneurysms (RAAs) are an uncommon finding but are more often associated with other congenital disorders. The complex (hilar) RAAs constitute a subset of RAAs that present a therapeutic dilemma for the vascular surgeon because of their anatomic location. This dilemma worsens when hilar RAAs occur with a solitary kidney where organ preservation is vital. Ex vivo reconstruction with autotransplantation is especially suitable for hilar RAAs, even when they are associated with a solitary kidney. We report 2 of such cases of RAAs with a solitary kidney in patients with pertinent congenital anomalies. In 1 case, the hilar RAA was associated with a significant accessory renal artery, whereas in the other case, the hilar RAA was associated with a significant connective tissue disorder. Ex vivo reconstruction and autotransplantation was successful in both cases; however, treatment modalities had to be adapted to the patient's unique conditions.
Collapse
Affiliation(s)
- Jaiyeola Adeyemi
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, MI
| | - Jacob Johnson
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, MI
| | - Yevgeniy Rits
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, MI
| | - A George Akingba
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, MI
| | - Jeffrey Rubin
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, MI.
| |
Collapse
|
6
|
Froehner M, Schaab F, Hofmockel T, Hoffmann RT, Fahlenkamp D, Wirth MP. Delayed Radiographic Manifestation of Renal Pseudoaneurysms After Blunt Trauma. Urology 2017; 103:e9-e10. [DOI: 10.1016/j.urology.2017.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 01/28/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
|
7
|
Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma. Case Rep Urol 2017; 2017:3017501. [PMID: 28386510 PMCID: PMC5366758 DOI: 10.1155/2017/3017501] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022] Open
Abstract
Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications.
Collapse
|
8
|
Kim MS, Lee YB, Lee JH, Lim CW, Kim JH, Choi HM, Oh DJ. Spontaneous rupture of a renal artery pseudoaneurysm in a previously hypertensive patient. Clin Hypertens 2015; 20:4. [PMID: 26893914 PMCID: PMC4745142 DOI: 10.1186/s40885-014-0011-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/05/2014] [Indexed: 12/19/2022] Open
Abstract
Previously, renal artery pseudoaneurysms were thought to be extremely uncommon. However, these lesions are now being detected more frequently as incidental findings on computed tomography, magnetic resonance imaging, and the extensive use of angiography. The incidence of ruptured renal artery pseudoaneurysms is very low. We report a case of a giant renal artery pseudoaneurysm (9.4-cm diameter) with severe left flank pain and a syncopal attack in a young woman who did not control high blood pressure for a couple of years.
Collapse
Affiliation(s)
- Myung-Sung Kim
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Young-Bae Lee
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Jae-Hyuk Lee
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Chae-Wan Lim
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Jun-Hyoung Kim
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Hye-Min Choi
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| | - Dong-Jin Oh
- Department of Internal Medicine, Myongji Hospital, 55 Hwasu-ro 14 beon-gil, Deogyang-gu, Goyang 412-826 Korea
| |
Collapse
|
9
|
Shuaib W, Tiwana MH, Vijayasarathi A, Sadiq MF, Anderson S, Amin N, Khosa F. Imaging of vascular pseudoaneurysms in the thorax and abdomen. Clin Imaging 2015; 39:352-62. [PMID: 25682302 DOI: 10.1016/j.clinimag.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 12/27/2014] [Accepted: 01/14/2015] [Indexed: 12/17/2022]
Abstract
INTRODUCTION This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.
Collapse
Affiliation(s)
- Waqas Shuaib
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA.
| | | | - Arvind Vijayasarathi
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | | | - Stephen Anderson
- Department of Radiology, Boston University School of Medicine, Boston, MA
| | - Neil Amin
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| | - Faisal Khosa
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA
| |
Collapse
|
10
|
Antunes-Lopes T, Pinto R, Morgado P, Madaleno P, Silva J, Silva C, Cruz F. Intrarenal artery pseudoaneurysm after blunt abdominal trauma: a case report of successful superselective angioembolization. Res Rep Urol 2014; 6:17-20. [PMID: 24809039 PMCID: PMC3979790 DOI: 10.2147/rru.s58291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Renal artery pseudoaneurysm is a very rare complication after blunt trauma injury. We report on a case of a 54-year-old man admitted to our hospital for right flank pain and gross hematuria, 5 days after blunt abdominal trauma. The diagnosis of interlobar renal pseudoaneurysm was established by a computed tomography scan and confirmed by angiography. Successful superselective angioembolization was performed. This radiographic intervention is an effective and minimally invasive technique to stop active bleeding from renal artery pseudoaneurysms, when patients are hemodynamically stable and where technically feasible. A review of the literature was carried out.
Collapse
Affiliation(s)
- T Antunes-Lopes
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - R Pinto
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - P Morgado
- Department of Radiology, Hospital de São João, Porto, Portugal
| | - P Madaleno
- Department of Radiology, Hospital de São João, Porto, Portugal
| | - J Silva
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - C Silva
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Cruz
- Department of Urology, Hospital de São João, Porto, Portugal ; Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
11
|
Judd E, Lockhart ME, Rizk DV. Renovascular hypertension associated with pseudoaneurysm following blunt trauma. Am J Kidney Dis 2013; 62:839-43. [PMID: 23518197 DOI: 10.1053/j.ajkd.2012.12.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/18/2012] [Indexed: 11/11/2022]
Abstract
We present the case of a 21-year-old man who developed a renal artery pseudoaneurysm following a 7-foot fall onto his back. He initially presented with gross hematuria, left flank pain, and back pain. He was observed in the hospital for 3 days and discharged. One week later, he was readmitted with headache, nausea, vomiting, seizure activity, and hypertension. Contrast-enhanced computed tomography of the abdomen showed a left renal artery pseudoaneurysm with associated arterial narrowing and delayed ipsilateral renal enhancement. He underwent percutaneous stent-graft placement with resolution of the pseudoaneurysm. He was free of complications and normotensive off antihypertensive medications after 36 months of follow-up. Renal artery pseudoaneurysms are rare and under-recognized complications of blunt abdominal or back trauma that can cause hypertension. Imaging modalities in renovascular hypertension have focused on detecting renal artery stenosis from atherosclerotic disease or fibromuscular dysplasia, with little attention given to renal artery pseudoaneurysms. In addition, first-line treatment for renal artery pseudoaneurysms historically has consisted of angioembolization, yet percutaneous stent-graft placement has emerged as an attractive alternative to preserve vessel patency. We discuss the role of imaging in renovascular hypertension with a focus on renal artery pseudoaneurysms and their prevalence, diagnosis, and treatment.
Collapse
Affiliation(s)
- Eric Judd
- University of Alabama at Birmingham, Birmingham, AL.
| | | | | |
Collapse
|
12
|
Yamaçake KGR, Lucon M, Lucon AM, Mesquita JLB, Srougi M. Renal artery pseudoaneurysm after blunt renal trauma: report on three cases and review of the literature. SAO PAULO MED J 2013; 131:356-62. [PMID: 24310805 PMCID: PMC10876317 DOI: 10.1590/1516-3180.2013.1315488] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 03/06/2013] [Indexed: 11/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Kleiton Gabriel Ribeiro Yamaçake
- Resident, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Marcos Lucon
- MD. Attending Physician, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Antonio Marmo Lucon
- MD, PhD. Assistant Professor, Department of Urology, Hospital das Cl ínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - José Luiz Borges Mesquita
- MD. Attending Physician, Department of Urology, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Miguel Srougi
- MD, PhD. Professor and Head, Department of Urology, Hospital das Cl ínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| |
Collapse
|
13
|
Affiliation(s)
| | | | - James Herman
- East Tennessee State University Johnson City, Tennessee
| |
Collapse
|
14
|
|