Renal Artery Aneurysm Mimicking Renal Calculus With Hydronephrosis

• Published in: American journal of kidney diseases Vol. 61; no. 6; pp. 1036 - 1040
• Main Authors: Chen, Shanwen, MD, Meng, Hongzhou, MD, Cao, Min, MD, Shen, Baihua, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2013; Elsevier
• Subjects: 3-dimensional reconstruction; Aneurysm - diagnosis; Biological and medical sciences; Diagnosis, Differential; Female; Humans; hydronephrosis; Hydronephrosis - diagnosis; Kidney Calculi - diagnosis; Kidneys; Medical sciences; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal Artery; renal artery aneurysm; Renal calculus; Renovascular diseases; Urinary system involvement in other diseases. Miscellaneous; Vascular Calcification - diagnosis; renal artery aneurysm; Renal calculus; hydronephrosis; 3-dimensional reconstruction; Kidney disease; Nephrology; Urinary system disease; Cardiovascular disease; Renal artery aneurysm; Urinary tract disease; Urology; Urinary stone; Hydronephrosis; Arterial disease; Vascular disease; Plasty; Renal lithiasis; Treatment; Surgery
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2012.10.023

A 51-year-old woman was found to have a left renal calculus with hydronephrosis. She underwent unsuccessful extracorporeal shock wave lithotripsy, leading to the recommendation that percutaneous lithotomy was necessary to remove the renal calculus. In view of the unusual shape of the calculus and absence of abnormalities in urine sediment, preoperative computed tomography and renal angiography were performed, which instead showed a calcified left renal artery aneurysm. Subsequent efforts to perform an aneurysmectomy also failed, eventually necessitating left nephrectomy. This case illustrates the pitfalls in the diagnosis of a renal artery aneurysm, which is a relatively common condition that may have unusual presentations. Hence, it is suggested that the possibility of a renal artery aneurysm be considered in the differential diagnosis when one detects a renal calculus with an unusual appearance. In addition, we propose that 3-dimensional reconstruction computed tomography be performed before considering surgical options for such renal calculi to rule out the possibility of a renal artery aneurysm.