Case report: Ruptured adrenal artery aneurysm

Abstract

A 62-year-old man presented with collapse and transient left-sided weakness in association with a one day history of right flank pain. He had experienced an episode of similar, but less severe, pain two weeks previously, when he had been admitted to another hospital with a provisional diagnosis o f renal colic. On this admission he was distressed, with tenderness in the right flank, but without a palpable mass. He was haemodynamically stable. Ultrasound (US) demonstrated an irregular, partly cystic, partly solid mass lying above the right kidney. Computed tomography (CT) showed the mass to be heterogeneous, with rim calcification. Part of the mass enhanced vividly following intravenous contrast medium administration (Fig. 1). The appearances were judged to be those of a visceral aneurysm, but the vessel o f origin was not apparent. Angiography was performed. Selective renal angiography demonstrated a hypertrophied right inferior adrenal artery, which supplied an aneurysm corresponding in position to the mass seen at US and CT (Fig. 2). At laparotomy, a large haematoma was found around the upper pole of the fight kidney, related to a 4 cm diameter aneurysm of the inferior adrenal artery. The adrenal gland itself appeared normal and was, therefore, not disturbed. The haematoma was evacuated, the feeding vessel ligated, and the aneurysm excised. Histological examination showed atheromatous change.