Abstract: SA-PO274
An Unusual Case of Hydronephrosis Caused by Iliac Artery Aneurysm
Session Information
- Trainee Case Reports - VI
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Reports
- 103 AKI: Mechanisms
Authors
- Nayyar, Kamal, NYU Winthrop Hospital, Mineola, New York, United States
- Drakakis, James, NYU Winthrop Hospital, Mineola, New York, United States
- Imbriano, Louis J., NYU Winthrop Hospital, Mineola, New York, United States
Introduction
Isolated internal iliac artery aneurysm is a rare but serious condition of which nephrologist should be aware. The natural history is one of continued expansion and rupture with high mortality rate. These can result in hydronephrosis and hydroureter with displacement of the ureter by a mass lesion.With proper treatment survival can be improved. Here we discuss a case of patient with acute renal failure in the setting of a pelvic kidney and symptomatic iliac artery aneurysm.
Case Description
A 66 year old male with a history of hypertension, hyperlipidemia, and smoking was admitted with angina. Serum creatinine was 1.7 mg/dl, and urinalysis showed trace proteinuria with no blood. Cardiac catheterization revealed 2 vessel disease. Within 12 hours of admission the patient developed vomiting, diarrhea, hypotension and new onset paresis of the left upper extremity. Creatinine rose in a saw-tooth pattern to 4.0 mg/dl over 5 days. MRI of the brain without contrast revealed a small right posterior frontal cortical infarct as well as multiple lacunes in the right basal ganglia, and 60% stenosis of the origin of the right internal carotid with an ulcerated plaque. During the angiogram, films of the aorta revealed mild right renal artery stenosis and an ectopic left pelvic kidney with hydronephrosis due to a 3.3 cm left common iliac artery aneurysm impinging on the ureter. Surgery was performed to repair the common iliac artery aneurysm and relieve the obstructed ureter of the pelvic kidney. Hydronephrosis of the left pelvic kidney was partially relieved, and subsequent renal scans showed no significant hydronephrosis.
Discussion
This patient demonstrates an obstructed pelvic kidney by an asymptomatic common iliac artery aneurysm. Isolated iliac artery aneurysms are exceedingly rare, account for <7% of all intra-abdominal aneurysms and are found in only 0.03% of the population in autopsy studies. They are most often due to atherosclerotic vascular disease occurring in males in the 7th or 8th decade. Symptoms vary and are related to pressure by the aneurysm on the ureter, the internal iliac vein, the lumbosacral nerve trunk, the external iliac vein, obturator nerve, and the colon. The risk of hydronephrosis may be increased in the pelvic kidney due to malrotation of the kidney and an anteriorly placed renal pelvis. This case exhibits the silent menace of an iliac artery aneurysm.