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Renal pseudoaneurysm

Posted Wed, 01/13/2010 - 09:33 by Shweta Bhatt
Images

Figure 1.

Figure 2. The yin yang pattern

Figure 3. To and fro waveform

Figure 4.


Clinical History:

64-year-old female with end stage liver disease being evaluated for liver transplant.


Findings:

Figure 1. Gray scale sagittal ultrasound of the right kidney shows an anechoic cystic structure at the lower pole (arrow)

Figure 2. Color Doppler image of the lesion shows a yin-yang patter of color flow within the lesion.

Figure 3. Spectral Doppler evaluation showed a to and fro pattern at the presumed neck of this pseudoaneurysm.

Figure 4. Contrast enhanced CT through the kidneys confirms the presence of a pseudoaneurysm (arrow) at the lower pole .


Diagnosis:

Renal pseudoaneurysm


Discussion:

Renal injury occurs in 8-10% of patients with abdominal trauma, and most of such injuries are caused by blunt trauma such as in motor vehicle accidents. Renal artery pseudoaneurysm is frequently reported in patients after penetrating trauma ( 1 ), but is usually rare after blunt trauma (2). It results as a result of full-thickness arterial injuries secondary to either direct impact or rapid deceleration . These pseudoaneurysms may bleed into the collecting system resulting in hematuria . Intrarenal aneurysms constitute 17% of all renal artery aneurysms (3)
Other causes of pseudoaneurysms in the kidneys may include renal biopsy or other interventional procedure such as nephrostomy.
Angiography is considered as the gold standard for diagnosis and treatment with selective embolization for intrarenal arterial lesions. Contrast enhanced CT is the modality of choice to identify these lesions non invasively. Ultrasound with color Doppler may also be able to identify pseudoaneurysms if of a reasonable size (4). Demonstration of a yin-yang pattern in the aneurysm sac and a to and fro patter at the neck of the pseudoaneurysm makes the correct diagnosis.


References / Suggested Reading:

1. Heyns CF, van Vollenhoven P. Increasing role of angiography and segmental artery embolization in the management of renal stab wounds. J Urol 1992;147:1231 -1234
2. Swana HS, Cohn SM, Burns GA, Egglin TK. Renal artery pseudoaneurysm after blunt abdominal trauma: case report and literature review. J Trauma 1996;40:459 -461
3. Smith JN, Hinman F , Intrarenal aneurysms. J. Urol 1967;97:990-996
4. More B, Chardran H, Pimpalwar A,John P. A traumatic intra renal pseudo-aneurysm in a child. Pediatric Surgery Int 2004; 20:729-730


Author

Shweta Bhatt, MD and Vikram S Dogra, MD

Assistant Professor (SB) and Professor (VSD) of Radiology

University of Rochester , Rochester, NY

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