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NewYork-Presbyterian Hospital Psychiatry
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Case of the Month - October 2018

This 62 year old female presented to the ED complaining of sudden right side/rib pain while bending over to pick something up about 45 minutes prior to admission. She had a CT renal stone ordered to evaluate the cause of her pain.

Question 1 : What’s wrong with this picture?

Question 1 X Ray

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Answer 1:

The CT was initially preliminarily read as calcified mass concerning for neoplasm but then re-read as calcified lesion suspicious for large renal artery aneurysm with adjacent hemorrhage concerning for aneurysm rupture. The patient was hemodynamically stable while in the ED.

Question 2 : Now What?

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Answer 2:

Surgery was consulted urgently and recommended a CT angio and transfer to the Columbia PACU (from Allen) for possible surgery. Her CT angio (see image below) confirmed acute to sub-acute hemorrhage into the right perirenal space likely due to prior rupture of right renal artery aneurysm. She underwent endovascular coiling of the aneurysm and was discharged home in stable condition 8 days later.

Question 2 X Ray
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