A 46 y/o male with gross hematuria

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Afshar Ebrahimi

 

Case Section

Cardiovascular

 

Patient's Information

Gender : Male
Age : 46

 

Clinical Summary

A 46 y/o male with history of nephrolithotomy presented with gross hematuria.

 

Imaging Findings

A contrast enhanced CT section shows a bilobulated structure 36mm in size in lower pole of left kidney that there is no communication with renal calyces and renal vein.

 

Differential Diagnosis

...

 

Final Diagnosis

Renal artery pseudoaneurysm

 

Discussion (Related Text)

Most renal artery pseudoaneurysms result from penetrating injuries, many of which are iatrogenic (e.g., associated with renal biopsy or nephrostomy tube placement. Hypertension and rupture with hemorrhage are the most important complications . Delayed hemorrhage (days to weeks after the initial injury) is not rare and may be heralded by hematuria. CT is highly reliable for diagnosing renal parenchymal and pyelocalyceal injuries, main renal arterial occlusion, and active bleeding. CT is not as accurate for diagnosing branch arterial injuries, including pseudoaneurysm or arteriovenous fistula. In kidneys that develop pseudoaneurysms, the initial CT scan often shows parenchymal laceration without pseudoaneurysm, because acute thrombus may temporarily seal the laceration. Over several days or weeks, clot lysis occurs with subsequent formation of a pseudoaneurysm. Communication with a renal vein branch creates an arteriovenous fistula. A typical pseudoaneurysm enhances in the arterial phase and washes out in the delayed phase.

 

References

1)Hassantash SA, Mock C, Maier RV. Traumatic visceral artery aneurysm: presentation as massive hemorrhage from perforation into an adjacent hollow viscus. J Trauma 1995; 38:357-360.
2) Fisher RG, Ben-Menachem Y, Whigham C. Stab wounds of the renal artery branches: angiographic diagnosis and treatment by embolization. AJR 1989; 152:1231-1235.
3)Heyns CF, van Vollenhoven P. Increasing role of angiography and segmental artery embolization in the management of renal stab wounds. J Urol 1992; 147:1231-1234.
4)Mukesh Kumar Vijay, Preeti Vijay,et al,Renal artery pseudoaneurysm following percutaneous nephrolithotomy, 2011,vol22,pp347-348.

 

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