Presentation
Non-specific left loin pain and history of urolithiasis and small stones passing, No previous surgical intervention.
Patient Data
Left renal hilar lower zone cystic lesion along the vessel course of mixed echogenicities, on Dolor doppler interrogation revealed a ying-yang swirling sign.
Mild dilatation of the left renal collecting system is also noted.
Contributed by Dr/ Shereen Ahmed
A well defined rounded lesion is seen at the left lower renal hilum related to renal vessels, elicits mixed low and high densities in non-enhanced CT with marginal punctuate mural calcifications, It shows partial eccentric intense enhancement in the arterial and portal phases similar to the blood pool, the remaining part appears hypodense and not enhanced with surface irregularities.
The posterior aspect of the left kidney shows hypodensity in the arterial phase with diminished cortical enhancement.
Few smaller renal stones are incidentally seen bilaterally.
Case Discussion
Left renal hilar lesion showing the degree of eccentric enhancement that is similar to the vascular blood pool is highly suggestive of a vascular lesion. A partially thrombosed saccular aneurysm is seen arising from distal left renal artery after its bifurcation.
Hypoperfused left renal posterior cortex (at risk of ischemia and infarction) possibly related to a localized mass effect of this lesion on its vascular supply.
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