Diagnosis Of Renal Artery Aneurysm Research Articles

Rare giant renal artery aneurysm in neurofibromatosis type 1 patient: a case report

Introduction and importance: Neurofibromatosis type 1 (NF1) is a genetic disorder characterised by multiple neurofibromas, café-au-lait spots, and iris hamartomas. The variety of vasculopathies that can occur in NF1 make it difficult for clinicians to accurately follow-up patients. Most cases of vasculopathies are stenotic, and, in few cases, aneurysms may form. Case presentation: A 35-year-old male presented with extreme left flank pain for the past 2 days. His physical examination revealed whole-body several café-au-lait skin macules, a subcutaneous lesion, and a palpable abdominal mass in the left flank. His laboratory workup was within normal ranges. A multi-slice computed tomography and computed tomography angiogram with contrast outlined a giant left renal artery aneurysm (RAA). A kidney salvage surgery was planned. However, due to ectatic dilatation and large extension of the aneurysm, the affected renal artery branches and renal vein were found unfit for auto-transplantation during the surgical procedure and a total nephrectomy was necessary. Symptoms improved significantly postoperatively and no complications developed. Clinical discussion: RAA is an uncommon finding in NF1 patients. Diagnosis is often dependent on computed tomography angiogram. Management techniques are conservative, endovascular, or surgical. In few surgical cases, a total nephrectomy may be necessary if auto-transplantation is not feasible. Conclusion: Despite its rarity, the diagnosis of RAA should be considered in patients with NF1 presenting with flank pain. Moreover, early screening for renal vasculopathies can evade critical surgical outcomes including a total nephrectomy. Hence, the authors recommend a total vascular workup for these patients, consisting of doppler ultrasound and, if necessary, a multi-slice computed tomography with contrast.

Diagnosis of Renal Artery Aneurysm by Point-of-Care Ultrasound in the Emergency Department: A Case Report and Brief Review of the Literature

BackgroundRenal artery aneurysm (RAA) is defined as a focal dilatation of ≥50% of the adjacent, disease-free artery. Although typically asymptomatic, RAA can lead to hypertension, hematuria, and rupture. The risk of rupture is higher in pregnant patients and may result in the death of the mother and the fetus. We describe a case of RAA discovered on point-of-care ultrasound (POCUS) in the emergency department. Case ReportA 46-year-old woman with no medical history presented to the emergency department with lower abdominal pain, vomiting, diarrhea, and increased urination. POCUS was performed to evaluate the cause of the patient's symptoms. This study revealed a 2.40 cm × 3.65 cm aneurysm in the right kidney. Why Should an Emergency Physician Be Aware of This?Rupture of RAA occurs in 3% to 5% of cases. Mortality to both the mother and the fetus is particularly high in gravid patients. RAA may be mistaken for other renal entities such as prominent renal veins or hydronephrosis. Properly identifying this pathology via POCUS can lead to early intervention. © 2022 Elsevier Inc.

Management and outcomes of isolated renal artery aneurysms in the endovascular era

Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms. We identified all patients undergoing open or endovascular repair of isolated renal artery aneurysms in the Nationwide Inpatient Sample from 1988 to 2011 for epidemiologic analysis. Elective cases were selected from the period 2000 to 2011 to create comparable cohorts for outcome comparison. We identified all patients with a primary diagnosis of renal artery aneurysms undergoing open surgery (reconstruction or nephrectomy) or endovascular repair (coil or stent). Patients with concomitant aortic aneurysms or dissections were excluded. We evaluated patient characteristics, management, and in-hospital outcomes for open and endovascular repair, and we examined changes in management and outcomes over time. We identified 6234 renal artery aneurysm repairs between 1988 and 2011. Total repairs increased after the introduction of endovascular repair (8.4 in 1988 to 13.8 in 2011 per 10 million U.S. population; P = .03). Endovascular repair increased from 0 in 1988 to 6.4 in 2011 per 10 million U.S. population (P < .0001). However, there was no concomitant decrease in open surgery (5.5 in 1988 to 7.4 in 2011 per 10 million U.S. population; P = .28). From 2000 to 2011, there were 1627 open and 1082 endovascular elective repairs. Patients undergoing endovascular repair were more likely to have a history of coronary artery disease (18% vs 11%; P < .001), prior myocardial infarction (5.2% vs 1.8%; P < .001), and renal failure (7.7% vs 3.3%; P < .001). In-hospital mortality was 1.8% for endovascular repair, 0.9% for open reconstruction (P = .037), and 5.4% for nephrectomy (P < .001 compared with all revascularization). Complication rates were 12.4% for open repair vs 10.5% for endovascular repair (P = .134), including more cardiac (2.2% vs 0.6%; P = .001) and peripheral vascular complications (0.6% vs 0.0%; P = .014) with open repair. Open repair had a longer length of stay (6.0 vs 4.6 days; P < .001). After adjustment for other predictors of mortality, including age (odds ratio [OR], 1.05 per decade; 95% confidence interval [CI], 1.0-1.1; P = .001), heart failure (OR, 7.0; 95% CI, 3.1-16.0; P < .001), and dysrhythmia (OR, 5.9; 95% CI, 2.0-16.8; P = .005), endovascular repair was still not protective (OR, 1.6; 95% CI, 0.8-3.2; P = .145). More renal artery aneurysms are being treated with the advent of endovascular techniques, without a reduction in operative mortality or a reduction in open surgery. Indications for repair of renal artery aneurysms should be re-evaluated.

Contrast-enhanced ultrasound reveals renal artery aneurysm after detection of ‘parapelvic lithiasis’

To the Editor Renal parapelvic calcifications are frequent ultrasonographic findings but are not always solely an expression of lithiasis; they may also occur in the setting of arterial aneurysms. Renal artery aneurysms account for 22 % of all visceral aneurysms, with a reported incidence of 0.7–1.0 % in large-scale screening studies [1–3]. Ultrasound plays a major role in the diagnosis of renal artery aneurysms, primarily because it is comparatively inexpensive, widely available and risk-free. However, this diagnostic approach has certain risks, as exemplified by the case we describe below. A 66-year-old Caucasian female with a history of hypertension and dyslipidemia was referred to our department for a colour Doppler examination. The aim of the examination was to exclude the presence of renal artery stenosis. Serum creatinine, blood urea and urinalysis were within normal limits. Abdominal ultrasonography (Sequoia Acuson 512 system, 4.0 MHz electronic probe, Siemens), revealed a roughly hyperechoic parapelvic mass in the right kidney, with a wide posterior shadow cone which made it impossible to study the entire structure of the lesion adequately, either with colouror power-flow. The mass had been previously described as lithiasis, but a hypoechoic space was noted below the hyperechoic stria (Fig. 1a). To better ascertain the nature of the lesion, contrast-enhanced ultrasonography was performed which revealed contrast medium flow below the hyperechoic structure, as through a vessel. This suggested a calcified renal artery aneurysm (Fig. 1b). Confirmatory contrast-enhanced computed tomography (CT) was then performed which revealed a 27 9 25-mm saccular aneurysm of the right renal artery middle branch (Fig. 1c). This case highlights the need to carefully examine renal vessels when performing renal ultrasonography, particularly when parapelvic calcifications are noted. Aneurysms may be identified along the entire course of the main renal artery as an outpouching tract, containing colour flow. Slow velocities and whirling flow patterns can usually be observed on Doppler studies. However, a calcified renal artery aneurysm may be difficult to distinguish from lithiasis or complicated cyst based only on power, colour or pulsed Doppler, due to the frequent presence of a posterior shadow cone. In this instance, contrast-enhanced ultrasonography might help clinicians in the diagnosis, thanks to low mechanical index and the use of contrast medium. A. Granata A. Clementi Department of Nephrology and Dialysis, ‘‘San Giovanni di Dio’’ Hospital, ASP, Agrigento, Italy

Renal artery aneurysms: presentation of five cases

We are presenting clinical characteristics, management and follow-up of five consecutive patients with renal artery aneurysm. Renal artery aneurysms are relatively uncommon, they rarely give rise to clinical manifestations and they are usually found incidentally. However with the introduction of Doppler ultrasound, computed tomography (CT) and magnetic resonance (MR) imaging, the diagnosis of renal artery aneurysms became more frequent.

Sonographic evaluation of renal artery aneurysm in childhood

We report a child presenting with renovascular hypertension and sonographic evidence of a renal artery aneurysm (RAA). The diagnosis of RAA was made sonographically by demonstrating vascular flow in an aneurysmal segment adjacent to but continuous with the right renal artery and externally compressing the inferior vena cava. Comparison of the sonographic studies and an abdominal angiogram illustrate the sensitivity of sonography in diagnosing this condition. We suggest that with renal doppler sonography, RAA may be diagnosed less invasively and possibly with greater frequency yet believe that the gold standard of angiography is necessary prior to surgical intervention.

Abdominal murmurs, an aid in the diagnosis of renal artery disease in hypertension.

Article1 March 1962Abdominal Murmurs, an Aid in the Diagnosis of Renal Artery Disease in HypertensionROY J. MOSER JR., M.D., JOHN R. CALDWELL, M.D.ROY J. MOSER JR., M.D.Search for more papers by this author, JOHN R. CALDWELL, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-56-3-471 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAs early as 1925, Fahr suggested that renal ischemia might be a cause of hypertension in patients with diffuse vascular disease (1). Goldblatt later provided experimental evidence of this important concept in renal artery ligation in dogs (2).In recent years, renal artery lesions frequently have been found in patients with hypertension. Some of these cases featured bruits as the only physical finding pointing to the diagnosis of renal artery aneurysm, renal arteriovenous fistula, or renal artery stenosis (3-5).Sokolow emphasized that a bruit over the upper abdominal aorta, renal arteries, or, less importantly, over the femoral arteries is one...