Renal Artery Aneurysm

Burst

Step 1: View clinicals

A 33 year old man presents with continuous pain in the left flank for one day, which progressively worsened over time, and was only minimally responsive to Ibuprofen. There was no history of fever, urinary symptoms or recent or past trauma to the affected area. His medical and surgical histories are unremarkable. He only drinks socially and does not smoke.


Step 2: Order all relevant investigations

Noncontrast CT abdomen

There are no renal or ureteric stones. The abdominal aorta appears normal.

CT Angiogram

There is an aneurysm in the distal portion of the left renal artery. A hemorrhage is noted in the superior pole of the left kidney, with ~65% necrosis of the parenchyma.

Urinalysis

Pus cells: nil/hpf Erythrocytes: 10 - 12/hpf No cell casts or crystals

Renal function tests

Blood urea: 17 mg/dL (3 - 20) S. Creatinine: 1 mg/dL (0.5 - 1.2)


Step 3: Select appropriate management

Nil Orally
IM Opioids
Coil Embolization
ACE inhibitors


Score: ★★☆