巨大肾实质内肾动脉瘤一例诊治报告并文献复习

doi:10.3877/cma.j.issn.1674-3253.2026.04.013

目的

分析肾实质内肾动脉瘤临床及影像学特点，旨在提高临床医师对该罕见病的诊治水平。

方法

回顾性分析2025年9月中山大学附属第三医院收治的1例肾实质内肾动脉瘤临床诊治过程并结合文献进行复习总结。

结果

肾实质内肾动脉瘤无典型临床表现。CT平扫可见界限清晰密度稍高病灶，增强CT皮质期病灶不均匀强化，髓质期均匀强化。该病例接受机器人辅助肾部分切除术，术中超声定位见瘤体内血液湍流，阻断肾动脉后湍流停止，考虑病变为肾动脉瘤，遂沿瘤体边界完整切除病灶。病理确诊：肾动脉瘤。

结论

肾实质内肾动脉瘤是一种罕见动脉畸形，易误诊为肾恶性肿瘤，贸然行肿物活检将会带来难以控制大出血。仅凭增强CT往往难以确诊，多普勒超声可见血液湍流，有助明确诊断。肾部分切除术完整切除瘤体，效果确切，患者预后良好。

关键词: 肾实质内肾动脉瘤, 罕见病, 肾部分切除术, 影像学特征

Objective

To analyze the clinical and imaging features of a case of intraparenchymal renal artery aneurysm (IPRAA), aiming to improve the clinical diagnosis and treatment of this rare disease.

Methods

A retrospective analysis was conducted on a case of IPRAA treated at the Third Affiliated Hospital of Sun Yat-sen University in September 2025. The clinical diagnosis and treatment process were reviewed, and relevant literature was summarized.

Results

The IPRAA showed no typical clinical manifestations. On non-enhanced CT, a well-defined mass with slightly higher density was observed. After contrast enhancement, the mass showed heterogeneous enhancement in the corticomedullary phase, homogeneous in the nephrographic phase. The patient underwent robot-assisted partial nephrectomy, intraoperative ultrasound localization revealed blood flow turbulence within the tumor, and the turbulence ceased after renal artery occlusion. The lesion was considered as renal artery aneurysm, and the lesion was completely resected along the boundary of the tumor. Pathology confirmed the diagnosis of renal artery aneurysm.

Conclusion

IPRAA is a rare arterial malformation that is easily misdiagnosed as a renal malignancy. Performing a biopsy on such a mass may result in uncontrollable bleeding. Contrast-enhanced CT alone is often insufficient for a definitive diagnosis, but Doppler ultrasound showing the characteristic of blood turbulence flow pattern can help clarify the diagnosis. Additionally, robot-assisted partial nephrectomy provides a reliable method for complete removal of the aneurysm, and the patient’s prognosis is favorable.

Key words: Intraparenchymal renal artery aneurysm, Rare disease, Partial nephrectomy, Imaging features

图1 肾实质内肾动脉瘤患者CT各期表现注：a示CT平扫见右肾下极团块状稍高密度灶，突向肾盏，大小约46 mm×55 mm×50 mm；b示皮质期病灶不均匀明显强化，中心片状低强化；c示髓质期病灶明显均匀强化，原中央低强化区被填充；d示CTA，未见明确动脉瘤腔与供血动脉直接连通的典型征象；箭头示病灶

图2 肾实质内肾动脉瘤大体标本及病理注：a为肾部分切手术标本，肿物呈现类圆形、厚壁囊性特征；b为病变呈囊性扩张，局部内衬扁平或立方上皮；c为囊壁由平滑肌与增生纤维组织构成（HE染色×100）

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A case report of giant intraparenchymal renal artery aneurysm and literature review

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A case report of giant intraparenchymal renal artery aneurysm and literature review