Department of Urology, the First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China.
Am J Kidney Dis. 2013 Jun;61(6):1036-40. doi: 10.1053/j.ajkd.2012.10.023. Epub 2013 Jan 3.
A 51-year-old woman was found to have a left renal calculus with hydronephrosis. She underwent unsuccessful extracorporeal shock wave lithotripsy, leading to the recommendation that percutaneous lithotomy was necessary to remove the renal calculus. In view of the unusual shape of the calculus and absence of abnormalities in urine sediment, preoperative computed tomography and renal angiography were performed, which instead showed a calcified left renal artery aneurysm. Subsequent efforts to perform an aneurysmectomy also failed, eventually necessitating left nephrectomy. This case illustrates the pitfalls in the diagnosis of a renal artery aneurysm, which is a relatively common condition that may have unusual presentations. Hence, it is suggested that the possibility of a renal artery aneurysm be considered in the differential diagnosis when one detects a renal calculus with an unusual appearance. In addition, we propose that 3-dimensional reconstruction computed tomography be performed before considering surgical options for such renal calculi to rule out the possibility of a renal artery aneurysm.
一位 51 岁女性被发现患有左肾结石伴肾积水。她曾接受过不成功的体外冲击波碎石术，因此建议进行经皮碎石术以去除肾结石。鉴于结石的形状异常且尿沉渣无异常，术前进行了计算机断层扫描和肾血管造影，结果显示左侧肾动脉钙化性动脉瘤。随后进行的动脉瘤切除术也失败了，最终不得不进行左肾切除术。本例说明了在诊断肾动脉动脉瘤时可能存在的陷阱，肾动脉动脉瘤是一种相对常见的疾病，可能会有不典型的表现。因此，建议在发现外观异常的肾结石时，考虑将肾动脉动脉瘤纳入鉴别诊断。此外，我们建议在考虑此类肾结石的手术方案之前，进行三维重建计算机断层扫描，以排除肾动脉动脉瘤的可能性。
