Presentation
Patient complaining of ongoing hematuria and Hgb 8g/dL. He was undergoing radiotherapy for recurrence of bladder urothelial cell carcinoma, complicated by right sided hydronephrosis with subsequent nephrostomy and antegrade ureteric stent placement. A CT angiogram was performed
Patient Data
Right nephrostomy placement and antegrade ureteric stenting
Routine right nephrostomy and antegrade ureteric stenting. Obvious hydroureteronephrosis.
Pseudoaneurysm arising from the right lower pole intrarenal artery protruding into the right lower pole renal pelvis. There is associated moderate distension of the right extrarenal pelvis secondary to hemorrhage and mild prominence of the right ureter.
Digital subtraction angiography
Selective catheterization of the right renal artery took place a Sos catheter, followed by a Progreat micro catheter, which was used to gain access to the lower pole division.
Right inferior renal artery pseudoaneurysm. Angiography revealed rapid shunting through the lower pole branch into a lower renal calyx.
Using super selective catheterization, coil embolization was performed and eventually all full flow to the pseudoaneurysm was terminated. Completion angiography reveals satisfactory flow to the remainder of the kidney.
Case Discussion
This case demonstrates an uncommon, but recognized major complication of percutaneous nephrostomy 1.
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