Name : Hamidreza
Affiliation : ----------------
Academic Degree: ----------------
Resident : Hussein Soleiman Tabar
Gender : Female
Age : 32
years old woman with history of SLE who has undergone a left renal biopsy.
Imaging Procedures and Findings
Images from selective left renal arteriogram show multiple intrarenal microaneurysms. A pseudoaneurysm with ongoing bleeding is formed at the lower pole of kidney secondary to iatrogenic trauma. Non contrast CT scan shows hematoma at perinephric space and jet of blood from the site of injury.
Renal artery aneurysms, exclusive of trauma, are rare (less than 0.1%). Aneurysms are basically of two types: extrarenal, caused by atherosclerosis and FMD; and small multiple ones within the kidney. The differential diagnosis of intrarenal microaneurysms includes PAN, Wegener granulomatosis, systemic lupus erythematosus, rheumatoid vasculitis, and drug abuse. Injury to kidney is not rare in either penetrating or major blunt trauma. A full range of vascular injuries can be seen from hematuria without visible injury (grade 1) to a shattered kidney or renal hilum avulsion (grade 5). Angiography is most often performed in these patients to determine the extent of injury and therapeutic planning, which may be surgical or via endovascular means. A special type of trauma to the kidney, of course, is iatrogenic, including biopsy or catheter placement. This also includes the renal transplant, which might be undergoing repeated biopsies. Angiography is performed to determine the site and nature of the injury, which could be pseudoaneurysm, arteriovenous fistula, or even extravasation. Most of these injury sites are amenable to endovascular treatment, most often by subselective catheterization and coiling.
Multiple intrarenal aneurysms on the background of SLE and a pseudoaneurysm with active bleeding formed after biopsy.
Brant WE, Helms CA. Fundamentals of Diagnostic Radiology, 3rd edition