PMC4961498_01
CT abdomen with contrast in late arterial phase showing a bilateral perirenal haematomas. There is an area of contrast extravasation in the upper pole of the right kidney (arrow) that suggests active bleeding; presence of coils (arrowhead) in the area previously embolized in the left kidney.
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An arterial phase CT of the abdomen was repeated and revealed a new, right this time, retroperitoneal haematoma with an area of contrast extravasation in the upper pole of the right kidney, suggesting the rupture of a microaneurysm in this area (Fig. 1).
a) Angiogram in late nephrographic phase after from a catheter placed in the right renal artery that shows the presence of a contrast blush from the upper pole of the right kidney (arrow). There is also presence of multiple very small other similar areas. b) Angiogram after superselective catheterization of the feeding branch confirms the presence of the pseudoaneurysm (arrow) and of an arteriovenous fistula (arrowhead). c) Angiogram that confirms the satisfactory exclusion of the lesion with coils and preservation of the vascularity of the residual renal parenchyma.
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The findings were confirmed angiographically after selective catheterization of the segmental branches of the right renal artery; furthermore an arteriovenous fistula was noticed in communication with the pseudoaneurysm and successful embolization of the vascular lesion with microcoils followed (Fig. 2).
Follow up CT abdomen scan with contrast showing reduction of the size of the perirenal haematomas, and no further area of bleeding. The coils are shown by the arrows.
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Creatinine levels returned back to patient's baseline levels of 90 mumol/L Further CT abdomen with contrast, 4 months later, showed both her kidneys to be well perfused (Fig. 3).