case_images: PMC11771203_01
case_images: Urinary CT revealed gas in the right renal parenchyma and perirenal with right hydronephrosis (A) and right ureteral calculi at the intersection with the iliac vessels (B). Repeat CT showed a significant improvement in right hydronephrosis and pyelonephritis with reduced gas accumulation (C).
case_images: fmed-11-1512449-g001.jpg
case_images: PMC11771203_01_fmed-11-1512449-g001.jpg
case_images: fig1
case_images: Gas was seen in the renal parenchyma, renal pelvis, and perinephric space, accompanied by right-sided hydronephrosis (Figures 1A,B). A follow-up CT scan performed 1 week later (Figure 1C) showed a significant reduction in hydronephrosis and resolution of perinephric inflammation.
case_images: Urinary CT showed slightly more hydronephrosis in the right kidney and more perirenal inflammation than before (A), and soft tissue density shadows are seen around the inferior vena cava and the right common iliac vessels (B).
case_images: fmed-11-1512449-g002.jpg
case_images: PMC11771203_01_fmed-11-1512449-g002.jpg
case_images: fig2
case_images: A new contrast-enhanced CT scan revealed mild progression of hydronephrosis and increased perinephric inflammation (Figure 2).
case_images: Contrast-enhanced CT findings: (A) The boundary between the lesion and the psoas major muscle, as well as the blood vessel, was unclear. A right common iliac aneurysm (red arrow), approximately 2.2 cm in diameter, and a right ureteral stent (blue arrow) were observed. (B) The right kidney appeared to be atrophied, irregularly shaped, and surrounded by mild inflammation. (C) Follow-up contrast-enhanced CT showed that the enhancement shadow around the iliac artery (yellow arrow) had significantly increased in size compared to the previous scan and exhibited an irregular shape. A mass-like shadow (red arrow) with a density lower than that of arterial blood vessels was observed, suggestive of rupture of the right common iliac aneurysm with localized encapsulation.
case_images: fmed-11-1512449-g003.jpg
case_images: PMC11771203_01_fmed-11-1512449-g003.jpg
case_images: fig3
case_images: A contrast-enhanced CT scan performed shortly thereafter revealed a right common iliac artery aneurysm, with gas accumulation and soft tissue shadows adjacent to the right iliopsoas muscle (Figures 3A,B). Surprisingly, 2 weeks later, a repeat contrast-enhanced CT scan (Figure 3C) showed that the aneurysm had ruptured but was contained by a surrounding fibrous capsule, preventing further hemorrhage.