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肾动脉假性动脉瘤

Renal artery pseudoaneurysm.

作者信息

Roman Luiz Inácio, Efel Cauana Fabrício, França Victória Teles, Merten Carolina Meert, Dummer Claus Dieter

机构信息

Universidade de Santa Cruz do Sul, Faculdade de Medicina, Santa Cruz do Sul - RS, Brazil.

Hospital Santa Cruz, Santa Cruz do Sul - RS, Brazil.

出版信息

J Bras Nefrol. 2017 Oct-Dec;39(4):458-461. doi: 10.5935/0101-2800.20170080.

Abstract

The renal artery pseudoaneurysm embody a rare vascular complication coming of percutaneous procedures, renal biopsy, nephrectomy, penetrating traumas and more rarely blunt traumas. The clinical can be vary according the patient, the haematuria is the symptom more commom. Is necessary a high level of clinical suspicion for your diagnosis, this can be elucidated by through complementary exams as the eco-color Doppler and the computed tomography scan (CT). This report is a case of a patient submitted a right percutaneous renal biopsy and that, after the procedure started with macroscopic haematuria, urinary tenesmus and hypogastric pain. The diagnosis of pseudoaneurysm was given after one week of evolution when the patient was hospitalized because gross haematuria, tachycardia, hypotension and hypochondrium pain. In the angiotomography revealed a focal dilation of the accessory right renal inferior polar artery, dilation of renal pelvis and all the ureteral course with presence hyperdenso material (clots) inside the middle third of the ureter. The treatment for the majority of this cases are conservative, through arterial embolization, indicated for thouse of smaller dimensions in patients who are hemodynamically stable. However, it was decided by clinical treatment with aminocaproic acid 1 g, according to previous studies for therapy of haematuria. The patient received discharge without evidence of macroscopic haematuria and with normal renal ultrasound, following ambulatory care.

摘要

肾动脉假性动脉瘤是经皮手术、肾活检、肾切除术、穿透性创伤以及较少见的钝性创伤后罕见的血管并发症。临床表现因患者而异,血尿是最常见的症状。诊断需要高度的临床怀疑,可通过彩色多普勒超声和计算机断层扫描(CT)等辅助检查来明确。本报告介绍了一例接受右侧经皮肾活检的患者,术后出现肉眼血尿、里急后重和下腹部疼痛。一周后,患者因肉眼血尿、心动过速、低血压和季肋部疼痛住院,诊断为假性动脉瘤。血管造影显示右肾副下极动脉局灶性扩张,肾盂及整个输尿管行程扩张,输尿管中三分之一内有高密度物质(血块)。大多数此类病例的治疗是保守的,通过动脉栓塞,适用于血流动力学稳定的小尺寸患者。然而,根据以往血尿治疗研究,决定对该患者采用1g氨基己酸进行临床治疗。患者出院时无肉眼血尿证据,门诊随访时肾脏超声检查正常。

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