Presentation
Left loin pain
Patient Data
Ultrasound study shows left renal hilar cystic-like lesion of complex echogenicity measures about 37 x 35 mm showing internal flow on color duplex and Doppler interrogation likely vascular in nature.
A well-defined rounded lesion is seen at the left renal hilum related to the renal vessels, measures 3.5 x 4 x 3.5 cm, elicits mixed low and high densities in the non-enhanced CT with marginal punctuate calcifications, it shows partial intense enhancement in the arterial phase with the remaining part appears hypodense and not enhanced consistent with a partially thrombosed renal artery aneurysm.
The posteromedial aspect of the left renal cortex shows hypodensity in the arterial phase with diminished enhancement suggestive of cortical hypoperfusion/ ischemia.
Left renal minute stones are noted.
Post endovascular intervention trial
Post endovascular intervention shows a failure of the embolized material to target the aneurysm lumen that still seen partially vascularized similar to the initial study. The coil appears as a dense linear metallic material anterolateral to the aneurysm, extending intrarenal.
Hypoperfusion/ ischemia of the renal cortex is progressing.
Case Discussion
Management of the renal artery aneurysms depends on various factors like age, sex, the severity of hypertension, anticipated pregnancy, and aneurysm morphology. In any young female with anticipated pregnancy, embolization or endovascular intervention is suggested.
If the aneurysm size is >1.5 cm:
- consider surgical or endovascular repair
- surgical treatment is recommended for aneurysms >2 cm in size
This case is an example of failed endovascular intervention for a large renal artery aneurysm (> 2cm) in a young female, surgical treatment was the last choice.
Additional contributors Dr.Shereen Ahmed and Dr. Mohamed Mahmoud Elthokapy