Renal artery aneurysm causing hydronephrosis

Giant Renal Artery Aneurysm With Hydronephrosis and Severe Atrophy of the Renal Parenchyma: Case Report and Literature Review

Background:

It is known that renal artery aneurysms may lead to hydronephrosis, but utter shrinking of the renal parenchyma due to a giant renal artery aneurysm has not yet been reported. This report is of an 88-year-old woman with resistant hypertension, hydronephrosis, and renal atrophy due to a giant saccular aneurysm of the left renal artery.

Case Report:

The patient presented with 2 weeks of worsening low back pain on the left side and resistant hypertension. The discovery of a left flank mass on physical examination, lead to the ultrasound detection of a para-aortic mass and a cyst-like partially septate structure replacing the left kidney. Thereafter, a contrast-enhanced computed tomography scan revealed a giant saccular aneurysm of the left renal artery causing severe hydronephrosis with severe parenchymal thinning. The extreme parenchymal atrophy of the left kidney made it an unlikely culprit of resistant hypertension, therefore the interventional radiologist considered that an endovascular attempt to re-establish the patency of the left renal artery would have scarcely produced any benefit. Given the advanced age of the patient, the vascular surgeon considered that risk of a nephrectomy outweighed the benefit, in agreement with the patient’s unwillingness to accept an invasive intervention. Therefore, she was discharged with blood pressure lowering and pain relief medication and was thereafter lost to follow-up.

Conclusion:

To our knowledge, this is the most severe kidney parenchymal shrinking in association with a renal artery aneurysm reported in the literature.

Imaging of a renal artery aneurysm detected incidentally on ultrasonography

Renal artery aneurysms occur with a frequency of less than 1% of the general population. Even if they are usually asymptomatic and incidentally found, they can be complicated with life-threatening conditions like rupture, thrombosis, embolism, or hypertension. Thus, once diagnosed, they should be fully evaluated with further imaging and treated when indicated. We present the case of a patient who was referred for ultrasonography for an unrelated reason. The examination demonstrated a hyperechoic focus near the right kidney. Further imaging workup with MDCT established the diagnosis of a right renal artery aneurysm which was saccular in shape and peripherally calcified. This ring-like calcification was also visible in a KUB radiography which was also performed. After presenting the case, various aspects of this rare entity are discussed.

Symptomatic hydronephrosis from renal artery aneurysm associated with fibromuscular dysplasia: management with transarterial embolization

A 56-year-old woman presented with right-sided flank pain, dizziness, and nausea. Ultrasonography revealed hydronephrosis of the right kidney. CT showed a nodular mass at the ureteropelvic junction. Subsequent CT angiography revealed the nodular mass as a distal aneurysm of the right renal artery compromising the ureteropelvic junction. Selective diagnostic angiography confirmed the diagnosis of a distal renal artery aneurysm. Moreover, angiography incidentally detected fibromuscular dysplasia of both renal arteries. The renal artery aneurysm was then successfully managed by transarterial embolization using detachable bioactive coils.