Presentation
Incidental finding during work-up for acute appendicitis. The patient has no significant past medical history.
Patient Data
The left renal artery has a saccular aneurysm at the renal pelvis. There is mural calcification and irregular soft plaque. The aneurysm measures 2.5 x 2.0 x 2.75 cm (width x anteroposterior x craniocaudal). There is extrinsic compression of the left renal pelvicalyceal system with moderate hydronephrosis and cortical thinning especially of the upper and mid poles.
The right kidney is normal in size and polarity with normal uptake and excretion of contrast. There is no nephroureterolithiasis bilaterally. The left renal vein runs inferiorly to join the proximal IVC/right common iliac vein at the level of the aortic bifurcation (type IV, renal vein anomaly).
The appendix is normal. There is a previous hysterectomy; CT imaging is otherwise unremarkable.
Image courtesy: Dr. I Carim.
Case Discussion
There is an incidental identification of a saccular left renal arterial aneurysm (type I) in an asymptomatic female patient. Renal arterial aneurysms are more common in female patients and at the median age of 50 years, as is the case here.
CT demonstrates an unusual complication of the aneurysm due to its anatomical location at the renal pelvis, specifically, the extrinsic compression of the pelvicalyceal system and consequent focal hydronephrosis, of the upper and mid pole.
There is no background contributory history of prior trauma, vasculitis, or phakomatoses.
The patient was referred for a dual urological and vascular surgical assessment before further imaging or endovascular intervention.
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