32 years old woman with history of SLE who has und

 

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Doctor's Information

Name :  Hamidreza
Family :Haghighatkhah
Affiliation : ----------------
Academic Degree: ----------------
Email :   This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident :  Hussein Soleiman Tabar

 

Patient's Information

Gender :  Female
Age :  32

 

Case Section

Interventional Radiology

 

Clinical Summary

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.

 

Discussion

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.

 

Final Diagnosis

Multiple intrarenal aneurysms on the background of SLE and a pseudoaneurysm with active bleeding formed after biopsy.

 

References

Brant WE, Helms CA. Fundamentals of Diagnostic Radiology, 3rd edition

 

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