Pseudoaneurysm of the Left Renal Segmental Artery With Delayed Detection After Blunt Trauma.

BACKGROUND Renal pseudoaneurysms can occur following penetrating renal trauma, renal surgery, or renal biopsy, and are a cause of delayed bleeding. However, cases occurring after blunt trauma are rare, and pseudoaneurysms may become apparent in a delayed fashion after initially negative imaging. CASE REPORT A 52-year-old man sustained trunk injuries in a motorcycle accident, including left renal injury (American Association for the Surgery of Trauma [AAST] Grade III) and splenic injury (AAST Grade IIIa or IIIb). Transcatheter arterial embolization was performed for the splenic injury, and the left kidney was managed conservatively. The patient developed fever on post-injury day 5, and computed tomography on day 6, performed to evaluate the fever source, did not demonstrate a pseudoaneurysm. Gross hematuria later worsened, with progressive anemia. On day 12 after injury, a new pseudoaneurysm was identified, and transcatheter arterial embolization was performed using n-butyl-2-cyanoacrylate and microcoils. Additionally, a ureteral stent was placed due to concomitant urinary fistula. Subsequently, fever and hematuria improved, and the patient was transferred to the urology ward on day 20 after injury. Urinary extravasation can contribute to pseudoaneurysm formation; therefore, repeat imaging and timely intervention should be considered in selected high-risk patients. CONCLUSIONS Delayed detection of renal segmental artery pseudoaneurysm should be considered after blunt renal trauma. Minimally invasive endovascular treatment is effective and kidney-sparing. Concomitant urinary extravasation and urinary fistula may contribute to delayed bleeding complications; therefore, repeat imaging and timely intervention should be considered in selected high-risk patients.