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Case Reports
. 2017 Oct 8;9(10):e1758.
doi: 10.7759/cureus.1758.

Retroperitoneal Pseudoaneurysm Mimicking Ureteral Calculus: Pitfalls in Diagnosis

Aleksandr Kalabin  1 , Vishnu R Mani  2 , Anant Dinesh  1 , Marina Landa  3 , Brian Davis-Joseph  4
Affiliations
Case Reports

Retroperitoneal Pseudoaneurysm Mimicking Ureteral Calculus: Pitfalls in Diagnosis

Aleksandr Kalabin et al. Cureus. .

Abstract

Arterial aneurysms (AA) can be classified as true aneurysms, characterized by the persistence of all three layers of the arterial wall with progressive dilation and wall thinning; arterial pseudoaneurysms (APAs) are characterized by a tear in the vessel wall and a periarterial hematoma formation. They could occur due to a visceral, retroperitoneal, or peripheral origin. Most AA/APA are usually found incidentally, and it is imperative to be vigilant in order to diagnose and manage them due to their potentially life-threatening complications. We present a case of a 35-year-old woman presenting with right-sided abdominal pain mimicking renal colic with an initial misdiagnosis of ureteral calculus. Post-cystoscopy, a misdiagnosis was confirmed, and subsequently, the patient had a right retroperitoneal mass excision. The histopathology report concluded the calcified retroperitoneal mass to be pseudoaneurysm. Such pitfalls in diagnosis are essential to be shared with the larger medical community for increased vigilance and optimal management of pseudoaneurysms.

Keywords: hematoma; misdiagnosis; pseudoaneurysm; ureteral calculus.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed tomography of the abdomen and pelvis
Right retroperitoneal high density mass (red arrow) on the anterior surface of psoas muscle.
Figure 2
Figure 2. Right retroperitoneal mass
Intraoperative finding of right retroperitoneal firm mass (white arrow), measuring 1.5 cm in greatest dimension with attached rubbery tail-like tissue (red arrow)
Figure 3
Figure 3. Final pathology report
Pathology slide (H & E stain) shows cross-section of arterial segment exhibiting a breach in the vessel wall. The vascular wall is extensively collagenized and partially calcified. Inset: Van Gieson stain highlights the breach in the vessel wall.
See this image and copyright information in PMC

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