PMC5964565_01
Lower extremity physical exam findings leading to the further workup of embolic and infectious sources, Osler nodes on the right foot, and decreased perfusion of the left leg due to proximal arterial occlusion in the iliac and superficial femoral arteries.
CRIS2018-7080813.001.jpg
PMC5964565_01_CRIS2018-7080813.001.jpg
fig1
On exam, the left anterior calf and foot were ecchymotic and poikilothermic, and there were multiple tender, raised red lesions consistent with Osler nodes at the plantar surface of the right foot (Figure 1).
CT axial images demonstrating (a) normal caliber left renal artery 3 weeks prior to presentation, (b) 1.65 cm left renal artery aneurysms, and (c) 3D reconstruction of left renal artery aneurysm (arrow).
CRIS2018-7080813.002.jpg
PMC5964565_01_CRIS2018-7080813.002.jpg
fig2
CT scan taken 3 weeks prior to admission showed a normal caliber left renal artery (Figure 2(a)); however, an abdominal CT scan on admission revealed a 1.65 cm left renal artery aneurysm (Figures 2(b) and 2(c)). CTA of the lower extremity demonstrated 50% left iliac stenosis and superficial femoral artery occlusion with popliteal reconstitution and no runoff to the foot.
Operative exposure during left renal artery aneurysm (arrow) resection and repair. Proximal and distal control is obtained, and the left renal vein is retracted cephalad.
CRIS2018-7080813.003.jpg
PMC5964565_01_CRIS2018-7080813.003.jpg
fig3
The renal aneurysm was repaired with a midline transperitoneal approach, and the left gonadal and adrenal veins were ligated for exposure (Figure 3).