PMC9549187_01
Left renal artery aneurysm on abdominal ultrasound (with the transducer
positioned in the left flank) (A) It is showed that the heterogeneous mass
(open arrows) is tangent to the calcified aortic wall (white arrowheads).
Contributing to the heterogeneity of the mass are both areas of increased
echogenicity (thick white arrow) reflecting a higher degree of fibrous
organization and echo-free areas representing persistent blood flow (white
star). The slim white arrow points to the lumen of the aorta (B) It is
showed a mass with heterogeneous structure (open arrows) and, adjacent to
it, a cystic mass (slim white arrows) with several septum-like structures
projecting inwardly (white thick short arrows). White arrowheads point to
the boundary between the 2 structures. There is a calcification throwing an
acoustic shadow inside the mass (thick white arrow).
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Consequently, abdominal ultrasound was performed and revealed a 100 mm mass in the left flank immediately adjacent to the calcified aortic wall (Figure 1A) and no obvious left kidney:instead, immediately adjacent to the mass, there was a cyst-like oblong structure of about 90 mm in length and 50 mm in width, with several septum-like structures projecting inwardly over a distance of about 1 cm from the wall of the cyst (Figure 1B). CT angiography appears quite distant from the aorta (Figure 3), although the wall of the thrombosed aneurysm was in contact with the aortic wall, as demonstrated by both ultrasound (Figure 1A) and CT (Figure 2D). CT scan also revealed degenerative changes in the spine with diffuse bone demineralization, reduced vertebral body height of the second lumbar vertebra and body compression fracture of the third lumbar vertebra.
Giant left renal artery aneurysm on contrast-enhanced computed
tomography:axial section through upper abdomen (A and B), sagittal
reconstruction (C) and coronal reconstruction (D) A. It is showed a giant
saccular almost completely thrombosed aneurysm of the left renal artery
(open arrows) with discrete parietal calcifications (white arrowheads).
There is a nodular calcification at the superior posterior pole of the
aneurysm (white thick arrow). Persistent blood flow inside the aneurysm is
marked by a black star. Black arrowheads point to the boundary between the
giant aneurysm and hydronephrotic left kidney (slim white arrows) B. It is
showed the thrombosed aneurysm of the left renal artery (open white arrows),
the severely hydronephrotic left kidney with extreme parenchymal atrophy
(slim long white arrows) in which the atrophied renal (Bertin) columns are
still visible (white arrowhead). The border between the aneurysm and the
hydronephrotic left kidney is indicated by black arrowheads C. The
relationship between the thrombosed aneurysm (open arrows) and the
hydronephrotic kidney (slim white arrows) is clearly visible. Black
arrowheads point to the border between the 2 structures. Black stars
indicate areas of blood flow (D) The relationship between the thrombosed
aneurysm (open arrows) and the aorta (black star) is clearly visible. Black
arrowheads point to the border between the 2 structures, demonstrating that
the thrombosed aneurysm is in close contact with the calcified aortic
wall.
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A contrast-enhanced thoracic and abdominal computed tomography (CT) showed a normal right kidney, but for a left lower polar cortical cyst of 27 mm, and a giant (transaxial diameters of 109 x 102 mm, cranio-caudal diameter of 94 mm), saccular, almost completely thrombosed aneurysm of the left renal artery with discrete parietal calcifications, a 13 x 9 mm nodular calcification at the superior-posterior pole (Figure 2A), and no active contrast media extravasation in the retroperitoneum. The giant aneurysm compressed the left kidney pelvis causing severe hydronephrosis with extreme thinning of the renal parenchyma (to a thickness of 2 mm) and of renal Bertin columns which appeared as thin septa-like structures (Figure 2B and C). CT angiography appears quite distant from the aorta (Figure 3), although the wall of the thrombosed aneurysm was in contact with the aortic wall, as demonstrated by both ultrasound (Figure 1A) and CT (Figure 2D). CT scan also revealed degenerative changes in the spine with diffuse bone demineralization, reduced vertebral body height of the second lumbar vertebra and body compression fracture of the third lumbar vertebra.
A portion of the aneurysm seen on computed tomography angiography. Only a
small portion of the aneurysm is visualized (thin white arrow) (as most of
the volume of the aneurysm is occupied by thrombotic material):consequently
there appears to be a large distance separating the "aneurysm" from the
aorta (although computed tomography and ultrasound clearly demonstrated that
the aneurysm borders medially on the aorta:see Figures 1A and 2D). Some diffusely delineated
"vascular" trajectories are visible in the intervening space (arrowheads).
Left kidney (thick white arrows) is visible behind the aneurysm.
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CT angiography appears quite distant from the aorta (Figure 3), although the wall of the thrombosed aneurysm was in contact with the aortic wall, as demonstrated by both ultrasound (Figure 1A) and CT (Figure 2D). CT scan also revealed degenerative changes in the spine with diffuse bone demineralization, reduced vertebral body height of the second lumbar vertebra and body compression fracture of the third lumbar vertebra.