Learning objectives
To highlight a rare manifestation of renal artery pseudoaneurysm presenting as a duodenal ulcer, requiring multidisciplinary management.
Background
Pseudoaneurysms arise from traumatic disruption of the arterial wall. Blood, dissects into the tissues adjacent to the vessel forming a contained, perfused sac limited by media, adventitia or simply the soft tissue adjacent to the vessel.
The majority of renal artery pseudoaneurysms are related to blunt penetrating trauma, with a recognised proportion iatrogenic. Pseudoaneurysm of the renal artery secondary to peri-inflammatory vessel injury is not commonly reported.[1,2]
We present a case of a patient with retroperitoneal abscess who subsequently developed a right renal artery pseudoaneurysm...
Imaging findings OR Procedure details
Case History
-70F transferred from overseas hospital for ongoing care 5/52 post admission for perforated duodenal ulcer. Initial presentation of haematemesis, malaena was managed with 16U PRBC.
-Large retroperitoneal collection of gas and fluid.-Percutaneous drainage of the collection produced relatively low volume of blood stained purulent output.
-D3 Duplex sonography revealed a below knee DVT managed with prophylactic enoxaparin.
-D7 acute deterioration with signs of hypovolaemia associated with malaena and drop in haemoglobin from 82 to 64 g/L. Subsequent CT angiogram demonstrated a pseudoaneurysm arising...
Conclusion
While renal artery pseudoaneurysm is a relatively well recognized entity, one resulting from an infective causation appears considerably less so. It is also unique that the lesion presented clinically with gastrointestinal haemorrhage. Management of such a lesion presents many interesting challenges; overcome in this case through thorough multi-disciplinary discussion and collaboration.
References
1. Ngo TC, Lee JJ, Gonzalgo ML. Renal pseudoaneurysm: an overview. Nat Rev Urol. 2010 Nov;7(11):619-25.
2. Sildiroglu, O., Saad, W.E., Hagspiel, K.D.et al.Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms.Cardiovasc Intervent Radiol35, 1340–1345 (2012).
Fig. 1, 2, 3 and 4 are © Department of Radiology, Alfred Health, Australia 2016(Primary author's affiliation is currently Monash Health)