This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited.  
© 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada.

Key Words Competing Interests Article Information

Renal cell carcinoma, pseudoaneurysm,  
renal artery embolization

None declared.

Patient consent: obtained.

Received on May 21, 2022 
Accepted on May 24, 2022

Soc Int Urol J. 2022;3(6):501–502

DOI: 10.48083/RHXJ2561

Renal Cell Carcinoma With Intratumoral 
Pseudoaneurysm 
Daniel P. Pierce,1 Elias H. Salloum,2 Philippe E. Spiess2

1 University of South Florida Department of Urology, Tampa, United States 2 Moffitt Cancer Center, Tampa, United States

Pseudoaneurysms can be present both pre- and postoperatively, occurring as frequently as 23% of the time by 
postoperative day seven. This specific case was found secondary to a standard preoperative evaluation and workup 
in a patient with otherwise undisturbed surgical fields suggesting de novo formation within the renal tumor. Factors 
considered for preoperative intervention included size of overall tumor, size of pseudoaneurysm, complex surgical 
anatomy of renal vasculature, and baseline risk of major intraoperative or postoperative hemorrhage. Renal artery 
embolization was performed using multiple detachable Concerto microcoils, resulting in complete occlusion. The 
following day via a subcostal incision the left upper pole and main renal arteries and vein were controlled, allowing 
for safe removal of the left kidney and adrenal gland with minimal measured blood loss at 300 mL and an uneventful 
postoperative course.

FIGURE 1. FIGURE 2. 

Coronal CT demonstrating a 10.3 cm × 8.7 cm × 6.5 cm solid and cystic 
enhancing left renal mass arising from the medial aspect of the upper 
pole, engulfing the left adrenal gland, and invading the left renal hilum. 
Also captured within this image are 2 of 3 pseudoaneurysms (PSA) with 
the largest measuring approximately 3 cm and an inferior multilobulated 
PSA measuring 1.5 cm

Coronal CT depicting yet another PSA at the origin of a more superior of  
2 renal arteries measuring just under 1 cm

501SIUJ.ORG SIUJ  •  Volume 3, Number 6  •  November 2022

CLINICAL PICTURE

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FIGURE 3. FIGURE 4. 

Digital subtraction angiogram of the superior left renal artery confirming a 
total of 3 PSA, the more proximal originating at the renal artery orifice

Post embolization angiogram demonstrating stasis of the renal artery 
without opacification of the 3 cm PSA. Also noted is retained contrast 
within the inferior multilobulated PSA confirming occlusion of the  
feeding vessel

502 SIUJ  •  Volume 3, Number 6  •  November 2022 SIUJ.ORG

Renal Cell Carcinoma With Intratumoral Pseudoaneurysm

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