[Ruptured pseudoaneurysm of the renal artery associated with segmental arterial mediolysis].
We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.
Mizutani
Kosuke
K
Department of Urology, Gifu University Graduate School of Medicine.
Kikuchii
Mina
M
Kondo
Hiroshi
H
Moriyama
Yoji
Y
Tsuchiya
Tomohiro
T
Masahiro
Nakano
N
Hidetoshi
Ehara
E
Deguchii
Takashi
T
Shinoda
Ikuo
I
D000368:Aged; D017541:Aneurysm, False / Q000209:etiology* / Q000628:therapy; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000628:therapy; D015653:Cystectomy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004621:Embolization, Therapeutic; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D011183:Postoperative Complications; D012077:Renal Artery; D017540:Tunica Media / Q000473:pathology*; D014519:Ureterostomy; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014652:Vascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000473:pathology