Renal arterial pseudoaneurysm

Case contributed by Dr Raazi Bajwa

Presentation

Patient complaining of ongoing haematuria 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

Age: 80-85
Gender: Male
Fluoroscopy

Right nephrostomy placement and antegrade ureteric stenting

Routine right nephrostomy and antegrade ureteric stenting. Obvious hydroureteronephrosis.

CT

CT angiogram

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 haemorrhage and mild prominence of the right ureter.

DSA (angiography)

Digital subtraction angiography

Selective catheterisation 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 catheterisation, coil embolisation 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 recognised major complication of percutaneous nephrostomy 1.

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Case information

rID: 37879
Case created: 24th Jun 2015
Last edited: 26th Oct 2015
Inclusion in quiz mode: Included

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