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ARTERIAL PSEUDOANEURYSM AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
0022-5347/05/1734-1366/0 THE JOURNAL OF UROLOGY® Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION
Vol. 173, 1366, April 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000156968.72834.3f
Radiology Page ARTERIAL PSEUDOANEURYSM AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY A 68-year-old white man presented with a history of gross hematuria confirmed on admission specimen. Urine culture yielded less than 10,000 organisms per ml and there was no growth in 2 days. Pertinent medical history included laparoscopic bilateral lymphadenectomies followed by radical prostatectomy 10 years earlier, coronary artery angioplasty and urolithiasis treated by extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on 2 occasions 4 years earlier. Since then there had been several episodes of gross hematuria with no definitive cause established by excretory urograms and multiple bladder biopsies. Computerized tomograms before ESWL demonstrated calculi in the calices of the left upper pole, with 1 possibly in a caliceal diverticulum (fig. 1). The current multiphasic helical tomogram showed no evidence of residual calculi but demonstrated several well delineated pseudoaneurysms in the left
upper pole, with 1 in the same location as the previously described calculus in the caliceal diverticulum (fig. 2). While no percutaneous nephrolithotripsy had been performed, which might have caused an arterial pseudoaneurysm, ESWL of a calculus in the confined space of a caliceal diverticulum may have caused injury to the wall of the adjacent vessels. The patient was offered superselective embolization of the pseudoaneurysm or heminephrectomy. In addition to stone load, location of calculi, particularly in confined spaces such as a caliceal diverticulum and in proximity to major branch arteries, must be considered when choosing ESWL therapy.
FIG. 1
FIG. 2
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Erich K. Lang and Val Earhardt Departments of Radiology and Urology Tulane University School of Medicine New Orleans, Louisiana
Vol. 173, 1366, April 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000156968.72834.3f
Radiology Page ARTERIAL PSEUDOANEURYSM AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY A 68-year-old white man presented with a history of gross hematuria confirmed on admission specimen. Urine culture yielded less than 10,000 organisms per ml and there was no growth in 2 days. Pertinent medical history included laparoscopic bilateral lymphadenectomies followed by radical prostatectomy 10 years earlier, coronary artery angioplasty and urolithiasis treated by extracorporeal shock wave lithotripsy (ESWL, Dornier Medical Systems, Inc., Marietta, Georgia) on 2 occasions 4 years earlier. Since then there had been several episodes of gross hematuria with no definitive cause established by excretory urograms and multiple bladder biopsies. Computerized tomograms before ESWL demonstrated calculi in the calices of the left upper pole, with 1 possibly in a caliceal diverticulum (fig. 1). The current multiphasic helical tomogram showed no evidence of residual calculi but demonstrated several well delineated pseudoaneurysms in the left
upper pole, with 1 in the same location as the previously described calculus in the caliceal diverticulum (fig. 2). While no percutaneous nephrolithotripsy had been performed, which might have caused an arterial pseudoaneurysm, ESWL of a calculus in the confined space of a caliceal diverticulum may have caused injury to the wall of the adjacent vessels. The patient was offered superselective embolization of the pseudoaneurysm or heminephrectomy. In addition to stone load, location of calculi, particularly in confined spaces such as a caliceal diverticulum and in proximity to major branch arteries, must be considered when choosing ESWL therapy.
FIG. 1
FIG. 2
1366
Erich K. Lang and Val Earhardt Departments of Radiology and Urology Tulane University School of Medicine New Orleans, Louisiana