Giant renal artery aneurysm

Case contributed by Dr Hein Els

Presentation

Right flank pain and hematuria. Rule out renal or ureteric stone. Additional history obtained after imaging: major motor vehicle collision decades earlier with major abdominal trauma that did not require surgical intervention.

Patient Data

Age: 39
Gender: Male
Modality: CT

Large expansile mass at the upper pole of the right kidney, likely at the renal sinus. The mass is partially surrounded by a thin layer of renal sinus fat and the overlying cortex is markedly thinned. The density is equal to the aorta at both phases of imaging. The right renal artery is markedly enlarged and feeds into the mass at its antero-superior margin. No enlarged renal vein. There are a few thin linear calcifications at the margin of the lesion. 

No renal calculi or hydronephrosis. The lower pole of the right kidney is normal. Moderate degree of stranding at the renal pelvis and along the proximal ureter. 

Modality: DSA (angiography)

The diameter of the right renal artery branch giving origin to the aneurysm measures 11mm. Multiple coils are deployed in the renal artery, markedly decreasing the flow to the aneurysm, but complete absence of aneurysmal supply is unfortunately not achieved. 

Flow to the lower pole of the kidney is preserved.

DSA images courtesy of Dr. P. Mouton.

Case Discussion

Giant renal artery aneurysms are extremely uncommon and only a few case reports exist in the literature. The etiology in our case is possibly due to major abdominal trauma suffered during childhood as the patient did not have any other comorbidities. 

Renal ultrasound one day after the coil embolization showed complete thrombosis of the giant renal artery aneurysm with no Doppler flow in the aneurysm. 

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Case Information

rID: 45980
Case created: 15th Jun 2016
Last edited: 23rd Nov 2016
System: Urogenital
Inclusion in quiz mode: Included

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