Spontaneous Ruptured Adrenal Artery Aneurysm

Abstract

Visceral artery aneurysm is an uncommon condition that can require emergency treatment. We describe a rare aneurysm in the left middle adrenal artery that spontaneously ruptured, leading to retroperitoneal hemorrhage. CASE REPORT A 68-year-old Japanese man with a history of coronary artery bypass grafting for angina pectoris, and a 1-year history of hypertension and renal insufficiency presented with left flank pain that had manifested suddenly while the patient was taking a hot bath. At presentation blood pressure was 118/70 mm. Hg and the patient was conscious. On examination the left abdominal wall was swollen and left lumbar pain was causing the patient severe distress. Laboratory tests showed severe anemia (hematocrit 18.3%, normal 38.2% to 50.8%). Computerized tomography revealed a large left retroperitoneal hematoma (fig. 1, A). Emergency aortography demonstrated an irregular aortic wall and an aneurysm of the left middle adrenal artery (fig. 1, B). Selective angiography showed that the aneurysm had ruptured and was bleeding into the retroperitoneal space (fig. 2, A). Transcatheter embolization was performed using 6 fibered 0.018-inch platinum microcoils (Tornado, Cook, Inc., Bloomington, Indiana) and a coaxial catheter system (Progreat, Terumo Corp., Tokyo, Japan). The distal tip of the catheter was positioned in the feeding artery just proximal to the aneurysm (fig. 2, B). The 6 fibered microcoils were positioned to obstruct completely the middle adrenal artery and the aneurysm. Temporary hemodialysis was necessary, because renal failure ensued. Symptoms subsequently resolved completely, and the patient was doing well at 11-month followup. DISCUSSION