• Seunghye Lee, Sehyun Jung, Hyun-Jung Kim, Ha Nee Jang, Dong Jun Park, Eunjin Bae, Tae Won Lee, and Se-Ho Chang.
• Department of Internal Medicine-Nephrology, College of Medicine, Gyeongsang National University.
• Medicine (Baltimore). 2021 May 21; 100 (20): e25970e25970.

RationaleRenal artery pseudoaneurysm is a rare vascular lesion usually caused by trauma or percutaneous urological procedures. Spontaneous rupture of pseudoaneurysms without predisposing events, especially in hemodialysis patients, has rarely been reported.Patient ConcernsA 25-year-old man receiving maintenance hemodialysis visited the emergency room because of sudden severe right flank pain. He had no history of trauma or urological procedures except for a left renal biopsy to diagnose Alport syndrome 10 years prior.DiagnosisContrast-enhanced computed tomography revealed a right perirenal hematoma with pseudoaneurysms.InterventionsOn renal angiography, multiple pseudoaneurysms were observed in the right renal artery branches and embolization was performed.OutcomesPost-angiography showed no pseudoaneurysms. His abdominal pain improved, and he was discharged 2 weeks after embolization.LessonsWhen maintenance dialysis patients complain of severe abdominal pain, spontaneous rupture of a renal pseudoaneurysm should be considered as a differential diagnosis, even if the patient has no history of trauma or previous urological procedures.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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