Spontaneously resolving large intrarenal artery aneurysm-a case report.

Case report

A 37-year-old man came to the hospital with a 1 week history of intermittent epigastric pain. Physical examination revealed elevated blood pressure (155/99 mmHg). The imaging analyses incidentally revealed turbulent blood flow and a cystic lesion with a diameter of 2.46 cm, which was confirmed as a saccular aneurysm on the basis of the computed tomography images (Figure 1). The patient refused intervention and underwent intermittent interrupted antihypertension treatment. Later, he was admitted for transcatheter arterial embolization, and then he was normotensive. There was no filling of the aneurysm during angiography (Figure 2), which was observed in the Doppler studies, confirming the spontaneous thrombosis of the renal aneurysm.

Fig. 1

(A) Sonography, (B) colour Doppler and (C) abdomen CT revealed an intrarenal aneurysm with a diameter of 2.46 cm, and (D) reconstruction images showed a solitary aneurysm receiving its blood supply from a segmental arterial branch (arrow).

(A) and (B) Angiography and (C) colour Doppler sonography revealed complete thrombosis of the aneurysm.

Discussion

Renal artery aneurysm is the term used to describe a dilated segment of the renal artery with more than twice the diameter of a normal artery. Conservative treatment is recommended for the management of small calcified aneurysms (diameter, 1.5 cm or lower) and asymptomatic normotensive individuals. Cases of symptomatic renal artery aneurysms and asymptomatic aneurysm with a diameter >2 cm are recommended for intervention [1,2]. In our case, the saccular aneurysm had a diameter >2 cm; therefore, intervention was proposed. The intervention revealed the spontaneous resolution of the aneurysm, which could be attributed to thrombosis. The causes of hypertension in renal artery aneurysm are not clear, but they may include renal ischemia due to turbulent blood flow [3]. After surgical reconstruction of the aneurysmatic vessel, 67% of the hypertensive patients became normotensive [4]. In our patient, the normotensive blood pressure after the thrombosis of the aneurysm confirmed the cause of the hypertension.

We reviewed Medline and found that there were no previous reports of large renal aneurysms that had been spontaneously resolved by thrombosis, but in our case, an aneurysm with a diameter >2 cm was resolved spontaneously.

Conflict of interest statement. None declared.