Renal Pseudoaneurysm Mimicking Local Cancer Recurrence After Partial Nephrectomy

Abstract

The development of an iatrogenic vascular lesion, such a renal pseudoaneurysm or arteriovenous fistula, is a rare complication of partial nephrectomy. These lesions should be considered in patients presenting with an enhancing mass in the resection bed shortly following partial nephrectomy. Early timing following surgery, large relative size, and the presence of recurrent hematuria suggest the diagnosis of an iatrogenic vascular lesion. Duplex ultrasound is a useful non-invasive imaging modality for differentiating these lesions from a local tumor recurrence.

‘Case of the Month’ from Thomas Jefferson University, Philadelphia, PA, USA: a large renal pseudoaneurysm masquerading as advanced renal cell carcinoma

“…There was a similar case reported by Campbell et al . [5], where a renal pseudoaneurysm mimicked tumour recurrence on CT after partial nephrectomy; however, unlike our present case there was known surgical insult to the area which led to the development of the pseudoaneurysm. These case reports showcase that commonly used diagnostic modalities might not differentiate vascular abnormalities from renal neoplasms and vascular malformation should be kept on the differential for renal masses [5–7].…”

“…[5], where a renal pseudoaneurysm mimicked tumour recurrence on CT after partial nephrectomy; however, unlike our present case there was known surgical insult to the area which led to the development of the pseudoaneurysm. These case reports showcase that commonly used diagnostic modalities might not differentiate vascular abnormalities from renal neoplasms and vascular malformation should be kept on the differential for renal masses [5–7]. This case also highlights the importance of a multidisciplinary approach to complex patient care, as without the expertise of each specialty involved, the clinical outcome for our patient could have been negatively impacted.…”

Large renal artery aneurysm masquerading as renal cell carcinoma

“…To date two cases of RAA mimicking neoplastic renal masses have been reported in the literature while two presentations with pseudoaneurysm have also been described. 2 , 3 , 4 , 5 Unfortunately both radical and partial nephrectomy have been performed where pre-operative radiological diagnosis of RCC was later proved incorrect on pathological analysis. 2 , 5 Whilst typically not standard practice, in this case US duplex was ordered to further clarify the architecture of the lesion and blood flow.…”

“…As a non-invasive means of further structural clarification when a high index of suspicion is exercised for lesions not entirely consistent with RCC US duplex is recommended as a further problem solving tool. 4 …”