Department of Urology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
BMC Nephrol. 2020 Aug 10;21(1):335. doi: 10.1186/s12882-020-01998-0.
Renal artery aneurysms (RAAs) are rare and usually asymptomatic, and some RAAs can be associated with calcifications, which may lead to misdiagnoses as renal calculi, which are then mistakenly treated.
A 69-year-old female patient was admitted to the hospital with no discomfort and was diagnosed with a large right renal calculus. The ultrasound and computed tomography urography (CTU) scan suggested a large calculus in the right pelvis with hydrops of the kidney. Therefore, we chose percutaneous nephrolithotomy (PCNL) to treat the right renal calculus, but no calculi were found in the renal pelvis. When we removed the mucosa of the renal pelvis with a holmium laser, we observed a fluctuating unruptured aneurysm with calcification. Therefore, the previous diagnosis of a renal calculus was disregarded. The operation was stopped immediately, and then computed tomography (CT) angiography was performed, confirming the right renal aneurysm with calcification. Then, Renal artery aneurysm (RAA) coil embolization was performed. After a long-term follow-up, the patient recovered well.
The RAA of this patient had calcific changes, which led us to errors in the diagnosis. Hence, it is very important for surgeons to effectively distinguish between renal calculi and aneurysms with ring-like calcifications. Our case report looks back at the thrilling situation during the operation and advises surgeons on how to deal with this situation properly.
肾动脉动脉瘤（RAA）罕见且通常无症状，有些 RAA 可伴钙化，这可能导致误诊为肾结石，从而被错误治疗。
一名 69 岁女性患者因无症状入院，被诊断为右肾结石。超声和 CT 尿路造影（CTU）扫描提示右骨盆有大结石，伴有肾积水。因此，我们选择经皮肾镜碎石术（PCNL）治疗右肾结石，但在肾盂中未发现结石。当我们用钬激光切除肾盂黏膜时，我们观察到一个波动的未破裂的钙化性动脉瘤。因此，我们忽略了之前的肾结石诊断。手术立即停止，随后进行 CT 血管造影（CTA），证实为右肾钙化性动脉瘤。然后进行了肾动脉动脉瘤（RAA）线圈栓塞术。长期随访后，患者恢复良好。
该患者的 RAA 有钙化改变，这导致了我们的诊断错误。因此，外科医生有效区分肾结石和环状钙化的动脉瘤非常重要。我们的病例报告回顾了手术中的惊险情况，并就如何正确处理这种情况向外科医生提供了建议。
