Primary Renal Vein Aneurysm Rupture: Case Report of a Catastrophic Entity

Incidental finding of circumaortic left renal vein aneurysm on imaging

“…Of the incidentally found RVAs, four were found on imaging 2,4-6 and one at the time of nephrectomy. 3 Abdominal pain was the presenting symptom in six cases [7][8][9][10][11] and hematuria in four patients. 7,[12][13][14] Etiology was unknown for most cases 2,4,6,7,11,14 ; however, five were thought to be related to arteriovenous fistula or other vascular malformation, 5,8,13,15,16 two were thought to be related to malignancy, 3,12 and one attributed to nutcracker syndrome.…”

“…3 Abdominal pain was the presenting symptom in six cases [7][8][9][10][11] and hematuria in four patients. 7,[12][13][14] Etiology was unknown for most cases 2,4,6,7,11,14 ; however, five were thought to be related to arteriovenous fistula or other vascular malformation, 5,8,13,15,16 two were thought to be related to malignancy, 3,12 and one attributed to nutcracker syndrome. 10 Complications ranged from none to thrombosis, pulmonary thromboembolism, and rupture.…”

“…Aneurysm rupture was reported in one patient requiring nephrectomy. 11 Management was primarily based on presentation and complications attributed to the aneurysm.…”

“…12 One patient presented in shock and was found to have a large retroperitoneal hematoma from a ruptured RVA, for which he underwent nephrectomy because of limited resource setting. 11 The final case involved a RVA with associated vascular malformation and PE with negative workup. The RVA and malformation were resected; pathology showed thrombus in the malformation to which the PE was attributed.…”

“…In the cases where nephrectomy was performed, there were no renal abnormalities on pathology. [11][12][13] Val-Bernal et al justified J o u r n a l P r e -p r o o f 6 nephrectomy by believing the large renal hilar mass on preop imaging was a malignancy. There was no justification for nephrectomy given in the two other case reports [11][12][13] ; it is possible that nephrectomy was performed due to loss of the vein.…”