Images in Clinical Urology Rupture of Renal Artery Aneurysm: A Rare Urologic Emergency Entity Haijiang Zhou, Wenpeng Yin, Yong Yan, Tianfei Lan, and Chunsheng Li We hereby introduce a rare case of ruptured renal artery aneurysm and make a simple description of this urologic emergency entity to enhance our awareness of this disease. UROLOGY 84: e25ee26, 2014. 2014 Elsevier Inc.
Figure 2. Transverse plane of the computed tomography scan revealed a ruptured renal artery aneurysm with perirenal hematoma in the right kidney and an atrophic left kidney.
Figure 1. Three-dimensional reconstruction of abdominal computed tomography angiography revealed an intrarenal renal artery aneurysm in the right kidney.
A
52-year-old man presented to the emergency room due to a 4-hour long right flank pain. He had no nausea, vomiting, fever, or hematuria. Physical examinations revealed tenderness in right epigastric region and percussion pain in right kidney region. Abdominal computed tomography angiography revealed a ruptured renal artery aneurysm (RAA) in his right kidney (Figs. 1-3). Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; the Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; and the Department of Dermatology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China Address correspondence to: Chunsheng Li, M.D., Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical University, No.8 Gongti South Street, Chao-yang District, Beijing 100020, China. E-mail: [email protected] Submitted: May 20, 2014, accepted (with revisions): August 5, 2014
ª 2014 Elsevier Inc. All Rights Reserved
Figure 3. Transverse plane of the computed tomography scan revealed perirenal hematoma in the retroperitoneal space.
RAAs are extremely rare clinical entities, which constitute localized dilations of renal arteries and/or branches.1,2 RAAs can be classified into 4 basic categories: the saccular, fusiform, dissecting, or intrarenal,2-4 and saccular RAA is the most common type. Predisposing http://dx.doi.org/10.1016/j.urology.2014.08.002 0090-4295/14
e25
factors encompass congenital malformations of the kidneys, untreated hypertension, atherosclerosis, pregnancy, trauma, malignancy, renal angiomyolipoma, radiation, and consumption of cyclophosphamide.2-4 Clinical manifestations of RAAs vary from being asymptomatic to fatal rupture. Endovascular interventional surgery, especially transcatheter arterial embolization, is considered a choice of treatment. Open surgical treatments include onlay venous patch angioplasty after aneurysmectomy, renal artery reconstruction, or a kidney preservation technique such as autotransplantation, but most cases may require nephrectomy due to insufficient field vision caused by hematoma or hemodynamic instability.5 However, the consensus of treatment of RAAs is yet to be reached.
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References 1. Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysms. Case report with review and update of the literature. Int Urol Nephrol. 2004;36:409-416. 2. Fraser GE, Poncia H. Spontaneous renal artery aneurysm rupture: an unusual cause of abdominal pain and syncope. Emerg Med J. 2009;26: 619-620. 3. De Wilde V, Devue K, Vandenbroucke F, et al. Rupture of renal artery aneurysm into the renal pelvis, clinically mimicking renal colic: diagnosis with multidetector CT. Br J Radiol. 2007;80:e262e264. 4. Ozkan G, Ulusoy S, Dinc¸ H, et al. Bilateral asymptomatic giant renal artery aneurysm. Hippocratia. 2011;15:269-271. 5. Seo PW. Surgical treatment of ruptured renal artery aneurysm: a report of 2 cases. Korean J Thorac Cardiovasc Surg. 2013;46: 467-470.
UROLOGY 84 (6), 2014
Figure 2. Transverse plane of the computed tomography scan revealed a ruptured renal artery aneurysm with perirenal hematoma in the right kidney and an atrophic left kidney.
Figure 1. Three-dimensional reconstruction of abdominal computed tomography angiography revealed an intrarenal renal artery aneurysm in the right kidney.
A
52-year-old man presented to the emergency room due to a 4-hour long right flank pain. He had no nausea, vomiting, fever, or hematuria. Physical examinations revealed tenderness in right epigastric region and percussion pain in right kidney region. Abdominal computed tomography angiography revealed a ruptured renal artery aneurysm (RAA) in his right kidney (Figs. 1-3). Financial Disclosure: The authors declare that they have no relevant financial interests. From the Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China; the Department of Urology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China; and the Department of Dermatology, Affiliated Hospital of Chengde Medical College, Chengde, Hebei Province, China Address correspondence to: Chunsheng Li, M.D., Department of Emergency Medicine, Beijing Chao-yang Hospital, Capital Medical University, No.8 Gongti South Street, Chao-yang District, Beijing 100020, China. E-mail: [email protected] Submitted: May 20, 2014, accepted (with revisions): August 5, 2014
ª 2014 Elsevier Inc. All Rights Reserved
Figure 3. Transverse plane of the computed tomography scan revealed perirenal hematoma in the retroperitoneal space.
RAAs are extremely rare clinical entities, which constitute localized dilations of renal arteries and/or branches.1,2 RAAs can be classified into 4 basic categories: the saccular, fusiform, dissecting, or intrarenal,2-4 and saccular RAA is the most common type. Predisposing http://dx.doi.org/10.1016/j.urology.2014.08.002 0090-4295/14
e25
factors encompass congenital malformations of the kidneys, untreated hypertension, atherosclerosis, pregnancy, trauma, malignancy, renal angiomyolipoma, radiation, and consumption of cyclophosphamide.2-4 Clinical manifestations of RAAs vary from being asymptomatic to fatal rupture. Endovascular interventional surgery, especially transcatheter arterial embolization, is considered a choice of treatment. Open surgical treatments include onlay venous patch angioplasty after aneurysmectomy, renal artery reconstruction, or a kidney preservation technique such as autotransplantation, but most cases may require nephrectomy due to insufficient field vision caused by hematoma or hemodynamic instability.5 However, the consensus of treatment of RAAs is yet to be reached.
e26
References 1. Porcaro AB, Migliorini F, Pianon R, et al. Intraparenchymal renal artery aneurysms. Case report with review and update of the literature. Int Urol Nephrol. 2004;36:409-416. 2. Fraser GE, Poncia H. Spontaneous renal artery aneurysm rupture: an unusual cause of abdominal pain and syncope. Emerg Med J. 2009;26: 619-620. 3. De Wilde V, Devue K, Vandenbroucke F, et al. Rupture of renal artery aneurysm into the renal pelvis, clinically mimicking renal colic: diagnosis with multidetector CT. Br J Radiol. 2007;80:e262e264. 4. Ozkan G, Ulusoy S, Dinc¸ H, et al. Bilateral asymptomatic giant renal artery aneurysm. Hippocratia. 2011;15:269-271. 5. Seo PW. Surgical treatment of ruptured renal artery aneurysm: a report of 2 cases. Korean J Thorac Cardiovasc Surg. 2013;46: 467-470.
UROLOGY 84 (6), 2014
