PMC5152981_01
Abdominal CT demonstrates a large retroperitoneal hematoma due to left R-AML rupture
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Abdominal computed tomography (CT) examination performed with intravenous (IV) contrast material injection identified a heterogeneous mass of 9.5 x 6 cm on the left kidney that contained adipose tissue and a large field of hematoma that extended to the retroperitoneal field (Figure 1).
Selective angiogram of left upper renal artery demonstrates pseudoaneurysm in the tumor
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Both left renal arteries were selectively and individually catheterized with 5F diagnostic renal catheter, and the images obtained showed that the mid-zone segmental artery that originated from the renal artery on the top was feeding the R-AML; this artery was identified as having a pseudoaneurysm and extravasation (Figures 2 and 3).
Late arterial phase of left upper renal artery demonstrates abnormal vascularity of AML, and extravasation from the pseudoaneurysm
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Both left renal arteries were selectively and individually catheterized with 5F diagnostic renal catheter, and the images obtained showed that the mid-zone segmental artery that originated from the renal artery on the top was feeding the R-AML; this artery was identified as having a pseudoaneurysm and extravasation (Figures 2 and 3).
Angiogram before the contrast material injection shows glue cast (arrows)
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The lumen of the microcatheter was washed with 5% glucose solution and a mixture consisting of 1 mL NBCA glue (histoacryl, Braun), and 2 mL iodized oil (lipiodol ultra-fluid, Guerbet) was carefully injected into the feeding artery of the R-AML under fluoroscopic control (Figure 4).
Control angiogram after the embolization, demonstrates occlusion of the feeding artery of the AML with disappearance of the pseudoaneurysm and the tumor vascularity. It also demonstrates occlusion of a small branch other than the feeder of the AML (arrow)
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In the control angiography following embolization, we confirmed that the feeding artery of the R-AML was occluded completely and that the pseudoaneurysm and the extravasation had disappeared (Figure 5).
CT examination performed 31 months after the embolization reveals regression of the R-AML size
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The contrast CT examination performed 31 months after the procedure showed that the size of R-AML regressed to 4.4 x 3.5 cm, and there was no significant contrast enhancement inside the mass related to vascular structures or solid components (Figure 6).