Journal of Clinical Cases

Ruptured Renal Artery Pseudoaneurysm (Case Report)

Mychelly de Sá Carvalho, Juliana Gonçalves, Neyma Andria Ramos, Ana Karla Gaburri, Daniel Siquieroli Vilas Boas, William da Costa and Marcello Romiti*

Departments:
Universidade Federal de São Paulo (Unifesp), Santos, SP, Brazil.
Instituto de Medicina Cardiovascular (Angiocorpore), Santos, SP, Brazil.

Corresponding Author: William da Costa and Marcello Romiti

ABSTRACT

Introduction: Renal artery pseudoaneurysm is a rare vascular complication, which can be caused by percutaneous surgery, renal biopsy, nephrectomy, penetrating trauma and, more rarely, blunt trauma.

Clinical Case: Female, 63 years old, complaining of pain in the right lumbar region that began a week ago and hematuria for 1 day, reports falling down stairs with blunt trauma to the right flank 3 months ago. She was in a regular general condition, pale, tachycardic, hypotensive, with painful abdomen on the right flank. Upon admission, he presented a hemoglobin of 8.0, urine I with hematuria, renal function within normal limits, a tomography of the abdomen and pelvis with intravenous contrast was requested, which showed: two intralobar aneurysmal saccular formations next to the right renal pelvis, measuring 32 and 37 mm, with signs of rupture into the retroperitoneum in the posterior pararenal space of the flank, right iliac fossa. An arteriography was performed, which revealed a ruptured tamponade pseudoaneurysm, and a covered stent was implanted in the pseudoaneurysm of the right renal artery. The patient progressed post-operatively with improvement in pain complaints and gradual improvement in hematuria.

Discussion: Treatment can be surgical or conservative, endovascular treatment has been increasingly accepted as an alternative to conventional therapy, especially in complex and intraparenchymal cases.

Conclusion: Clinical history and physical examination are essential for the diagnosis of ruptured tamponade pseudoaneurysm, complementary exams are essential for diagnostic confirmation and surgical planning; Surgical treatment with covered stent implantation is an effective, minimally invasive treatment with satisfactory results.