NDT Plus (2009) 2: 427–428 doi: 10.1093/ndtplus/sfp086 Advance Access publication 16 July 2009
Images in Nephrology (Section Editor: G. H. Neild)
Spontaneously resolving large intrarenal artery aneurysm—a case report Yu L. Chen1 , Chien L. Chen1,2 , Kang J. Chou1,2 and Hua C. Fang1,2
Correspondence and offprint requests to: Chien-Liang Chen; E-mail: [email protected]
Keywords: renal artery aneurysm
Case report A 37-year-old man came to the hospital with a 1 week history of intermittent epigastric pain. Physical examination revealed elevated blood pressure (155/99 mmHg). The imaging analyses incidentally revealed turbulent blood flow and a cystic lesion with a diameter of 2.46 cm, which was confirmed as a saccular aneurysm on the basis of the computed tomography images (Figure 1). The patient refused intervention and underwent intermittent interrupted antihypertension treatment. Later, he was admitted for transcatheter arterial embolization, and then he was normotensive. There was no filling of the aneurysm during angiography (Figure 2), which was observed in the Doppler studies, confirming the spontaneous thrombosis of the renal aneurysm.
our case, the saccular aneurysm had a diameter >2 cm; therefore, intervention was proposed. The intervention revealed the spontaneous resolution of the aneurysm, which could be attributed to thrombosis. The causes of hypertension in renal artery aneurysm are not clear, but they may include renal ischemia due to turbulent blood flow [3]. After surgical reconstruction of the aneurysmatic vessel, 67% of the hypertensive patients became normotensive [4]. In our patient, the normotensive blood pressure after the thrombosis of the aneurysm confirmed the cause of the hypertension. We reviewed Medline and found that there were no previous reports of large renal aneurysms that had been spontaneously resolved by thrombosis, but in our case, an aneurysm with a diameter >2 cm was resolved spontaneously. Conflict of interest statement. None declared.
References
Discussion Renal artery aneurysm is the term used to describe a dilated segment of the renal artery with more than twice the diameter of a normal artery. Conservative treatment is recommended for the management of small calcified aneurysms (diameter, 1.5 cm or lower) and asymptomatic normotensive individuals. Cases of symptomatic renal artery aneurysms and asymptomatic aneurysm with a diameter >2 cm are recommended for intervention [1,2]. In
1. Tham G, Ekelund L, Herrlin K et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg 1983; 197: 348–352 2. Hupp T, Allenberg JR, Post K et al. Renal artery aneurysm: surgical indications and results. Eur J Vasc Surg 1992; 6: 477– 486 3. Youkey JR, Collins GJ Jr, Orecchia PM et al. Saccular renal artery aneurysm as a cause of hypertension. Surgery 1985; 97: 498– 501 4. Bastounis E, Pikoulis E, Georgopoulos S et al. Surgery for renal artery aneurysms: a combined series of two large centers. Eur Urol 1998; 33: 22–27 Received for publication: 1.4.09; Accepted in revised form: 23.6.09
C The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: [email protected]
Downloaded from http://ckj.oxfordjournals.org/ at McMaster University Library on March 17, 2015
1 Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and 2 Department of Internal Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
428
Y. L. Chen et al.
Fig. 2. (A) and (B) Angiography and (C) colour Doppler sonography revealed complete thrombosis of the aneurysm.
Downloaded from http://ckj.oxfordjournals.org/ at McMaster University Library on March 17, 2015
Fig. 1. (A) Sonography, (B) colour Doppler and (C) abdomen CT revealed an intrarenal aneurysm with a diameter of 2.46 cm, and (D) reconstruction images showed a solitary aneurysm receiving its blood supply from a segmental arterial branch (arrow).
Images in Nephrology (Section Editor: G. H. Neild)
Spontaneously resolving large intrarenal artery aneurysm—a case report Yu L. Chen1 , Chien L. Chen1,2 , Kang J. Chou1,2 and Hua C. Fang1,2
Correspondence and offprint requests to: Chien-Liang Chen; E-mail: [email protected]
Keywords: renal artery aneurysm
Case report A 37-year-old man came to the hospital with a 1 week history of intermittent epigastric pain. Physical examination revealed elevated blood pressure (155/99 mmHg). The imaging analyses incidentally revealed turbulent blood flow and a cystic lesion with a diameter of 2.46 cm, which was confirmed as a saccular aneurysm on the basis of the computed tomography images (Figure 1). The patient refused intervention and underwent intermittent interrupted antihypertension treatment. Later, he was admitted for transcatheter arterial embolization, and then he was normotensive. There was no filling of the aneurysm during angiography (Figure 2), which was observed in the Doppler studies, confirming the spontaneous thrombosis of the renal aneurysm.
our case, the saccular aneurysm had a diameter >2 cm; therefore, intervention was proposed. The intervention revealed the spontaneous resolution of the aneurysm, which could be attributed to thrombosis. The causes of hypertension in renal artery aneurysm are not clear, but they may include renal ischemia due to turbulent blood flow [3]. After surgical reconstruction of the aneurysmatic vessel, 67% of the hypertensive patients became normotensive [4]. In our patient, the normotensive blood pressure after the thrombosis of the aneurysm confirmed the cause of the hypertension. We reviewed Medline and found that there were no previous reports of large renal aneurysms that had been spontaneously resolved by thrombosis, but in our case, an aneurysm with a diameter >2 cm was resolved spontaneously. Conflict of interest statement. None declared.
References
Discussion Renal artery aneurysm is the term used to describe a dilated segment of the renal artery with more than twice the diameter of a normal artery. Conservative treatment is recommended for the management of small calcified aneurysms (diameter, 1.5 cm or lower) and asymptomatic normotensive individuals. Cases of symptomatic renal artery aneurysms and asymptomatic aneurysm with a diameter >2 cm are recommended for intervention [1,2]. In
1. Tham G, Ekelund L, Herrlin K et al. Renal artery aneurysms. Natural history and prognosis. Ann Surg 1983; 197: 348–352 2. Hupp T, Allenberg JR, Post K et al. Renal artery aneurysm: surgical indications and results. Eur J Vasc Surg 1992; 6: 477– 486 3. Youkey JR, Collins GJ Jr, Orecchia PM et al. Saccular renal artery aneurysm as a cause of hypertension. Surgery 1985; 97: 498– 501 4. Bastounis E, Pikoulis E, Georgopoulos S et al. Surgery for renal artery aneurysms: a combined series of two large centers. Eur Urol 1998; 33: 22–27 Received for publication: 1.4.09; Accepted in revised form: 23.6.09
C The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: [email protected]
Downloaded from http://ckj.oxfordjournals.org/ at McMaster University Library on March 17, 2015
1 Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and 2 Department of Internal Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
428
Y. L. Chen et al.
Fig. 2. (A) and (B) Angiography and (C) colour Doppler sonography revealed complete thrombosis of the aneurysm.
Downloaded from http://ckj.oxfordjournals.org/ at McMaster University Library on March 17, 2015
Fig. 1. (A) Sonography, (B) colour Doppler and (C) abdomen CT revealed an intrarenal aneurysm with a diameter of 2.46 cm, and (D) reconstruction images showed a solitary aneurysm receiving its blood supply from a segmental arterial branch (arrow).
