Unmasking Renal Artery Pseudoaneurysm: A Rare and Elusive Cause of Hypertension

A 49-year-old man with hypertension for 2 years, was incidentally found to have right intrarenal aneurysms during a routine abdominal ultrasound examination. He reported fluctuating blood pressure readings over the past 18 months. Laboratory parameters were within normal limits, with a serum creatinine level of 1.05 mg/dL. An abdominal CT angiogram revealed a large lobulated intrarenal aneurysm in the lower pole, which communicated with another smaller cortical aneurysm. Additional features suggested the presence of an arteriovenous (AV) fistula. Upon further questioning, the patient disclosed a history of blunt abdominal trauma following a motor vehicle accident 3 years ago. This trauma likely explains the CT findings and the development of hypertension secondary to renovascular disease in this patient. Angiography confirmed the presence of 2 renal artery pseudoaneurysms in the midpolar region, for which selective coil embolization was performed. The patient was stable and asymptomatic at his 2-week follow-up. His blood pressure reading was 110/80 mmHg, showing improvement compared to his pre-procedure recordings. There are very few reported cases of renal pseudoaneurysms causing secondary hypertension. Additionally, this case highlights that successful embolization can result in a substantial improvement in hypertension in these patients.