Life-threatening gross hematuria caused by giant renal artery branch aneurysm coexistent with artero-venous fistula leading to acute rupture of renal pelvis

Renal artery aneurysms (RAAs) are lesions with an incidence of less than 1% in the general population. The co-existence of these clinical entities with renal arteriovenous fistulas (AVF) has been rarely described. Often asymptomatic, these anomalies are commonly diagnosed during abdominal imaging. Endovascular techniques for the treatment of asymptomatic RAA and AVF have been described in sporadic clinical cases. We presented the case of an adult man who presented to our hospital with severe hemorrhagic shock because of a rupture of a giant aneurysm of the left renal artery with a concomitant artero-venous mal-formation and fistula in the urinary tract, requiring emergency nephrectomy.