A 62-year-old man with a 40-pack-year smoking history was referred to the urologic oncology clinic for workup of an incidentally discovered renal mass. After undergoing chest imaging for lung cancer screening, a right renal mass was found. Follow-up computed tomography (CT) imaging demonstrated a 7.5 × 7.4 × 7.5 cm well-circumscribed mass arising from the mid right kidney that enhanced homogenously with few calcifications. He did not have any recent surgeries or traumas. He was instructed to complete imaging work-up by obtaining a doppler ultrasound study. The ultrasound was completed on the same day and demonstrated a large vascular lesion with pulsatile flow concerning for a renal pseudoaneurysm. The patient was informed of the results and told to return promptly to the hospital for admission. After arriving, Interventional Radiology (IR) performed a renal angiogram which demonstrated a large aneurysm arising near the bifurcation of the right upper pole artery. IR attempted placement of a covered stent, but there was no good landing zone. A coil embolization was also considered, but it was ultimately deferred given the risk for infarction of a large portion of the right kidney. Given the possible need for vascular reconstruction, the patient was transferred to the vascular surgery service at a neighboring hospital. The vascular team discussed options with the patient including open surgical reconstruction or endovascular intervention. Open surgery could involve auto-transplantation of the kidney after ex vivo reconstruction of the aneurysm. Another option is local repair of the aneurysm in-situ with aneurysm excision and reimplantation of the superior pole branch of the renal artery. Alternatively, endovascular approaches including placement of a covered stent or renal angioembolization could also be performed. Ultimately, the patient and the vascular team agreed to repeat an attempt for placement of a covered stent. Selective angiogram of the right renal artery confirmed a renal artery aneurysm originating from the superior pole branch. Vascular surgery was able to pass a microwire and catheter into the superior pole artery but was unable to advance a larger wire that would facilitate the placement of a covered stent. The decision was made to proceed with coil embolization of the outflow and inflow tract. Subsequent angiography demonstrated good exclusion of flow into the aneurysm with maintained flow into the inferior renal pole branch. The patient tolerated the procedure well and was discharged from the hospital on postoperative day 1. The patient presented for outpatient follow-up on postoperative day 14 with new symptoms of nausea, abdominal pain, night sweats, and chills. He noted that his symptoms of nausea occurred specifically after eating fatty meals. Laboratory work showed no leukocytosis, anemia, or elevated creatinine, but there was a mild elevation in alanine aminotransferase. CT angiography (CTA) was performed and demonstrated metallic coiling in the right renal artery and a 7.5 cm aneurysm without contrast enhancement on arterial or delayed phases of imaging. Hypoperfusion of some areas of the kidney were also seen, consistent with infarction. At a 3-month follow-up visit, the patient reported feeling well and had resolution of prior symptoms. Repeat CTA showed stable size of the excluded renal aneurysm sac along with interval atrophy of the renal parenchyma consistent with prior renal infarct. Basic hematology and chemistry lab values were within normal limits. The patient is scheduled to return for additional follow-up 6 months after his procedure.