002K Post Biopsy Pseudoaneurysm Hemorrhage Subcapsular Hematoma Post Embolisation

  • 46 yo female with
  • PMH of
    • T2DM, HTN,
    • discoid lupus,
    • peripheral vascular disease and
    • PSUD (cocaine + alcohol) w
  • pw
    • oliguric renal failure requiring initiation of HD.
    • complicated by MSSA bacteremia from
      • right toe osteomyelitis which was further
    • complicated by
      • RUE abscess.

US – Increased Echogenicity 

46 year old female with discoid lupus erythematosus and renal failure. US shows increased echogenicity of the kidneys consistent with medical renal disease
Ashley Davidoff TheCommonVein.net
US guided renal Biopsy
46 year old female with discoid lupus erythematosus and renal failure. US shows increased echogenicity of the kidneys consistent with medical renal disease
This study shows biopsy needle in the cortex of the right kidney
Ashley Davidoff TheCommonVein.net

Biopsy Result

Kidney biopsy which preliminarily is showing 60% sclerosis with evidence of chronic active interstitial nephritis

Post Biopsy Non Contrast CT

46 year old female with discoid lupus erythematosus and renal failure. CTscan without contrast post biopsy shows a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net
46 year old female with discoid lupus erythematosus and renal failure. CTscan without contrast post biopsy shows a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net

CT Shows Active Bleeding and Pseudoaneurysms

Post Biopsy Arterial Phase CT

46 year old female with discoid lupus erythematosus and renal failure. CTscan during the arterial phase post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net
46 year old female with discoid lupus erythematosus and renal failure. CTscan during the arterial phase post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net
46 year old female with discoid lupus erythematosus and renal failure. CTscan during the arterial phase post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net
46 year old female with discoid lupus erythematosus and renal failure. CTscan during the arterial phase post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net

Post Biopsy Portal Venous Phase CT

Post Biopsy Portal Venous Phase CT
46 year old female with discoid lupus erythematosus and renal failure.  CTscan during the portal venous  phase  post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Post Biopsy Portal Venous Phase CT
46 year old female with discoid lupus erythematosus and renal failure.  CTscan during the portal venous  phase  post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Post Biopsy Portal Venous Phase CT
46 year old female with discoid lupus erythematosus and renal failure.  CTscan during the portal venous  phase  post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney
Post Biopsy Portal Venous Phase CT
46 year old female with discoid lupus erythematosus and renal failure.  CTscan during the portal venous  phase  post biopsy shows findings suggestive of pseudo-aneurysms and active bleeding with a large perinephric hematoma compressing the kidney

 

 

IR Angiography  Multiple PSA’s and Active Bleeding

IR Angiography  Multiple PSA’s and Active Bleeding
46 year old female with discoid lupus erythematosus and renal failure.  Angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms (white arrow)  and active bleeding (red arrow) with a large perinephric hematoma compressing the kidney
Ashley Davidoff TheCommonVein.net

Sub-selective IR Angiography  Pseudoaneurysm 

Sub-selective IR Angiography  Pseudoaneurysm 
46 year old female with discoid lupus erythematosus and renal failure.  Selective angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms and in a segmental artery in the lower pole
Ashley Davidoff TheCommonVein.net

IR Angiography Embolizations

 

IR Angiography Embolization
46 year old female with discoid lupus erythematosus and renal failure.  Selective angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms and in a segmental artery in the lower pole  Sub-selective catheterization with embolisation of 3 pseudoaneurysms and one active bleed
Ashley Davidoff TheCommonVein.net
IR Angiography Embolizations
46 year old female with discoid lupus erythematosus and renal failure.  Selective angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms and in a segmental artery in the lower pole  Sub-selective catheterization with embolisation of 3 pseudoaneurysms and one active bleed
Ashley Davidoff TheCommonVein.net

Final Result

Final Result Post IR Angiography Embolization
46 year old female with discoid lupus erythematosus and renal failure.  Selective angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms and in a segmental artery in the lower pole  Sub-selective catheterization with embolisation of 3 pseudoaneurysms and one active bleed
Ashley Davidoff TheCommonVein.net

46 year old female with discoid lupus erythematosus and renal failure.  Selective angiography injecting into the right renal artery   post biopsy shows findings suggestive of pseudo-aneurysms and in a segmental artery in the lower pole  Sub-selective catheterization with embolisation of 3 pseudoaneurysms and one active bleed

 

Ashley Davidoff TheCommonVein.net

Renal angiography demonstrates pseudoaneurysms involving three
subsegmental branches of the right renal artery and active contrast
extravasation from a fourth subsegmental branch. Selective catheterization
and coil embolization performed of each subsegmental branch to stasis.
Post embolization right renal angiography showed resolution of the
pseudoaneurysms and areas of active contrast extravasation. Mass effect
upon the right kidney seen from known perinephric hematoma.