Renal Cell Carcinoma with Intratumoral Pseudoaneurysm

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.