External iliac artery pseudoaneurysms after kidney transplantation

Case contributed by Oscar Manuel Franco Alba


Long-standing type II diabetes mellitus and end-stage renal disease. Kidney grafted three months ago. Nausea, vomit, anuria, leg swelling and pain located near the kidney graft for the last seven days.

Patient Data

Age: 55 years
Gender: Male

Double focal dilatation of the external iliac artery on a contrast-enhanced study.

Double J catheter is seen reaching transplant kidney pelvis.

Mild free ascites at the pelvis. Subcutaneous edema is noted as well.

Color Doppler ultrasound exam revealed two "yin-yang sign" within the external iliac artery, compatible with pseudoaneurysms.

Case Discussion

Iliac artery aneurysms are rare, they represent less than 2% of abdominal aneurysms. External iliac arterial involvement is very rare. Pseudoaneurysms are abnormal dilatations of arteries bounded only by the tunica adventitia. They are commonly associated with trauma. Yin-yang sign is an ultrasound feature described in pseudoaneurysms. A contrast-enhanced CT study might help confirm the diagnosis.

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