Partial nephrectomy via a laparoscopic approach can be technically challenging, and associated vascular complications such as pseudoaneurysm may occur. CT with CT angiography is ideal for the nonin-vasive imaging of this process. This article reports two cases of pseudoaneurysm of the renal artery detected on CT as a complication of laparoscopic partial nephrectomy and demonstrates the usefulness of 3-D CT angiography in the evaluation of vascular pathology.
Partial nephrectomy for patients with malignant renal tumors was introduced in the 1950s, but has recently become the procedure of choice for elective indications [1]. This is in response to improved surgical technique and the significant rise in the incidental CT detection of early stage renal cell carcinoma [2]. Early detection can be attributed to an overall increase in the number of CT scans performed, but is also the result of recent advances in technology including improved resolution afforded by multidetector CT scanning with 3-D vok" ume rendering. Conservative management is ideal for these small renal lesions, avoiding overtreatment for benign disease and sparing renal function in patients with renal cell carcinoma, who have a 3.8% risk of requiring further surgery for lesions in the contralateral kidney [3]. A laparoscopic rather than open approach is being performed increasingly for selected indications including benign diseases as well as for the removal of small exophytic tumors (<2cm) [4]. While the laparoscopic approach has the advantages of low morbidity and a better aesthetic result, the limited working space makes hemostasis challenging [5]. To our knowledge, there have been no reports in the literature documenting pseudoaneurysm as a complication of either open or laparoscopic partial nephrectomy. Here we present pseudoaneurysm of the renal artery as a complication of laparoscopic partial nephrectomy confirmed by conventional renal angiographies in two postoperative patients. In both cases, the multiplanar capabilities of multidetector CT combined with 3-D volume rendering aid in the accurate diagnosis.